Mamokant God Favor Health Care LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

MAMOKANT GOD FAVOR HEALTH CARE LLC

Practice address

1018 River Forest PT
Lawrenceville, GA 30045-2600

Phone

(941) 237-8179

NPI assigned

Jun 20, 2023

Organization subpart

No

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

Authorized official

Name

Marie Jose AntoineNPI 1922692169

Title

Owner

Phone

(678) 255-5917

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marie Jose Antoine, FNP-C

  • Family Nurse Practitioner
  • Lawrenceville, GA
  • NPI 1922692169
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715904000000",
    "number": "1336824077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1018 RIVER FOREST PT",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300452600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1018 RIVER FOREST PT",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300452600",
            "telephone_number": "941-237-8179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAMOKANT GOD FAVOR HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-20",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A",
        "authorized_official_last_name": "ANTOINE",
        "authorized_official_first_name": "MARIE JOSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-255-5917"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; 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.