Provider Demographics
NPI:1225033640
Name:OSMON, CARLOS A (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:OSMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 ROSELANE ST NW STE 710
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6975
Mailing Address - Country:US
Mailing Address - Phone:678-331-3297
Mailing Address - Fax:678-581-7187
Practice Address - Street 1:1700 HOSPITAL SOUTH DR STE 300
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8116
Practice Address - Country:US
Practice Address - Phone:770-944-2830
Practice Address - Fax:678-581-7170
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016653207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00114815EMedicaid
GA000114815HMedicaid
GA00114815AMedicaid
GA00114815DMedicaid
GA1225033640OtherNPI NUMBER
GA00114815GMedicaid
GA00114815EMedicaid