Covenant Medical Center PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

058389 Issued in GA

Legal business name

COVENANT MEDICAL CENTER PC

Practice address

3970 Five Forks Trickum Rd SW
Suite a
Lilburn, GA 30047-2339

Phone

(678) 357-1282

NPI assigned

Apr 7, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Cecilia O Babalola, MDNPI 1649315417

Title

Physician/Owner

Phone

(678) 357-1282

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Advantage Health & Rehab LLC

  • Internal Medicine Physician
  • Lawrenceville, GA
  • NPI 1629354303
  NPPES parent name

Practitioners 1

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

• Cecilia Omoyemi Babalola, MD

  • Internal Medicine Physician
  • Lilburn, GA
  • NPI 1649315417
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1239062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271721600000",
    "number": "1770726721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3970 FIVE FORKS TRICKUM RD SW",
            "address_2": "SUITE A",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300472339",
            "telephone_number": "678-357-1282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3970 FIVE FORKS TRICKUM RD SW",
            "address_2": "SUITE A",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300472339",
            "telephone_number": "678-357-1282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT MEDICAL CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-07",
        "last_updated": "2010-04-20",
        "status": "A",
        "authorized_official_last_name": "BABALOLA",
        "authorized_official_first_name": "CECILIA",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "678-357-1282",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "058389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Lilburn, GA
• Providers in Lilburn, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2010; 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.