Provider Demographics
NPI:1215493598
Name:OMNI INTEGRATIVE HEALTHCARE
Entity type:Organization
Organization Name:OMNI INTEGRATIVE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:POYTHRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-386-6510
Mailing Address - Street 1:2751 BUFORD HWY NE STE 700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5510
Mailing Address - Country:US
Mailing Address - Phone:404-386-6510
Mailing Address - Fax:
Practice Address - Street 1:2751 BUFORD HWY NE STE 700
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-5510
Practice Address - Country:US
Practice Address - Phone:404-386-6510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty