1245640820 NPI number — EFOSA OMONUWA OGIAMIEN MD

Table of content: EFOSA OMONUWA OGIAMIEN MD (NPI 1245640820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245640820 NPI number — EFOSA OMONUWA OGIAMIEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGIAMIEN
Provider First Name:
EFOSA
Provider Middle Name:
OMONUWA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OGIAMIEN
Provider Other First Name:
OSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1245640820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3390 PEACHTREE RD NE STE 1500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30326-2822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-920-4950
Provider Business Mailing Address Fax Number:
404-920-4959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1388 WELLBROOK CIR NE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONYERS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30012-3872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-920-4950
Provider Business Practice Location Address Fax Number:
404-920-4959
Provider Enumeration Date:
05/05/2014

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: 207L00000X , with the licence number:  82884 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 37064 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: 82884 , 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)