Provider Demographics
NPI:1063123933
Name:OMS PRIMARY CARE INC
Entity type:Organization
Organization Name:OMS PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMOKHUALE
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOKHODION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-672-6267
Mailing Address - Street 1:2145 ROSWELL RD STE 60
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-0819
Mailing Address - Country:US
Mailing Address - Phone:770-672-6267
Mailing Address - Fax:770-485-8665
Practice Address - Street 1:2145 ROSWELL RD STE 60
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-0819
Practice Address - Country:US
Practice Address - Phone:770-672-6267
Practice Address - Fax:770-485-8665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty