1629337514 NPI number — DR. FOZI OUSE ADEM PHARMD

Table of content: DR. FOZI OUSE ADEM PHARMD (NPI 1629337514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629337514 NPI number — DR. FOZI OUSE ADEM PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADEM
Provider First Name:
FOZI
Provider Middle Name:
OUSE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADEM
Provider Other First Name:
FOZI
Provider Other Middle Name:
OUSE
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629337514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 SOUTH LINK DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVINGTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-625-0230
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3140 TURNER HILL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITHONIA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-323-8559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH021538 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)