Provider Demographics
NPI:1063983799
Name:ACCESSIBLE WALK-IN CLINIC
Entity type:Organization
Organization Name:ACCESSIBLE WALK-IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DICKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:OSANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-226-9131
Mailing Address - Street 1:1206 J W DAVIS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5953
Mailing Address - Country:US
Mailing Address - Phone:985-956-7370
Mailing Address - Fax:985-956-7371
Practice Address - Street 1:1206 J W DAVIS DR STE 102
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5953
Practice Address - Country:US
Practice Address - Phone:985-956-7370
Practice Address - Fax:985-956-7371
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EPIPHANY HEALTHCARE SYSTEM, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1124202973OtherHOME CARE
GA1124202973Medicaid