Destiny Family Medical Center, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

064750 Issued in GA

Legal business name

DESTINY FAMILY MEDICAL CENTER, LLC

Practice address

3654 Chattahoochee Summit Dr SE
Atlanta, GA 30339-3254

Phone

(404) 721-2444

NPI assigned

Nov 16, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Olakunle Ajibola

Title

Chief Medical Officer

Phone

(404) 721-2444

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1384560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384560000000",
    "number": "1902236656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3654 CHATTAHOOCHEE SUMMIT DR SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303393254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3654 CHATTAHOOCHEE SUMMIT DR SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303393254",
            "telephone_number": "404-721-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINY FAMILY MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-16",
        "last_updated": "2013-11-16",
        "status": "A",
        "authorized_official_last_name": "AJIBOLA",
        "authorized_official_first_name": "OLAKUNLE",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "404-721-2444",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "064750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Semhar G Desta
• John William Destefano, MD
• Robert Destefano, MD
• Destination Greatness-Georgia, LLC
• Destination Unlimited Clinical Services, LLC
• Destiny'S Child Inc
• Destinys Doors LLC
• John R. Destito, DO
• Kim Desue
• Richard L Detlefs, M.D.

• Primary Care Clinic/Center in Atlanta, GA
• Providers in Atlanta, 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 Nov 16, 2013; 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.