Reneca Contracting & Consultant

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

060727 Issued in GA

Legal business name

RENECA CONTRACTING & CONSULTANT

Practice address

1525 E Park Place Blvd
Suite 300
Stone Mountain, GA 30087-3453

Phone

(770) 879-7707

Fax

(770) 879-7708

NPI assigned

Oct 17, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Ellis I Efobi, M.D

Title

Executive Director

Phone

(770) 879-7707

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1445040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445040000000",
    "number": "1306217294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 E PARK PLACE BLVD",
            "address_2": "SUITE 300",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873453",
            "telephone_number": "770-879-7707",
            "fax_number": "770-879-7708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 E PARK PLACE BLVD",
            "address_2": "SUITE 300",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873453",
            "telephone_number": "770-879-7707",
            "fax_number": "770-879-7708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENECA CONTRACTING & CONSULTANT",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-17",
        "last_updated": "2015-10-17",
        "status": "A",
        "authorized_official_last_name": "EFOBI",
        "authorized_official_first_name": "ELLIS",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "770-879-7707",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "GA",
            "license": "060727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Service Clinic/Center in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Health Service Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.