1922491380 NPI number — DR. AKINYI OSANO DAC, LAC. DOM

Table of content: DR. AKINYI OSANO DAC, LAC. DOM (NPI 1922491380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922491380 NPI number — DR. AKINYI OSANO DAC, LAC. DOM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSANO
Provider First Name:
AKINYI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DAC, LAC. DOM
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1922491380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6864
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOUGLASVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30154-0032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-871-1884
Provider Business Mailing Address Fax Number:
888-871-1884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7193 DOUGLAS BLVD STE 206
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOUGLASVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30135-1540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-871-1884
Provider Business Practice Location Address Fax Number:
888-871-1884
Provider Enumeration Date:
03/10/2015

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: 171100000X , with the licence number:  GA325 , 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)





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