NPIMap

Organization Active NPI

Covenant Medical Group LLC

  • Pulmonary Disease Physician
  • Marietta, GA
National Provider Identifier
1194235853
Registry record updated Oct 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
65598 Issued in GA
Legal business name
COVENANT MEDICAL GROUP LLC
Practice address
3605 Sandy Plains Rd Ste 240-235
Marietta, GA 30066-3068
Phone
(770) 990-8212
NPI assigned
Oct 9, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ngozika Orjioke, MDNPI 1275754731
Title
Ceo
Phone
(770) 990-8212

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X 65598 GA Primary

Addresses

Primary practice location

3605 Sandy Plains Rd Ste 240-235
Marietta, GA 30066-3068

Mailing address

2330 Tall Timbers LN
Marietta, GA 30066-2117
Phone (770) 990-8212

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180802003977 GA Part B Supplier - Clinic/Group Practice 4082969241 Receives reassigned benefits from 48 practitioners
Practice locations: Atlanta, GA; Douglasville, GA; Macon, GA; Riverdale, GA

National Provider Directory

National Provider Directory

Locations

3605 Sandy Plains Rd
Ste 240235
Marietta, GA 30066
Phone (770) 990-8212

483 Upper Riverdale Rd SW
Ste L
Riverdale, GA 30274
Phone (770) 742-3883

483 Upper Riverdale Rd SW
#L
Riverdale, GA 30274

Practitioners & affiliated clinicians

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 49

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507507200000",
    "number": "1194235853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 TALL TIMBERS LN",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300662117",
            "telephone_number": "770-990-8212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3605 SANDY PLAINS RD STE 240-235",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300663068",
            "telephone_number": "770-990-8212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-09",
        "last_updated": "2017-10-09",
        "status": "A",
        "authorized_official_last_name": "ORJIOKE",
        "authorized_official_first_name": "NGOZIKA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-990-8212",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "GA",
            "license": "65598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.