Provider Demographics
NPI:1306685151
Name:DAYE, OMAR
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:DAYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 ASHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4302
Mailing Address - Country:US
Mailing Address - Phone:919-824-1875
Mailing Address - Fax:
Practice Address - Street 1:1812 N BROWN RD STE 30
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-1801
Practice Address - Country:US
Practice Address - Phone:919-824-1875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABR0205591744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1744P3200XOtherA9282
GA1744P3200XOtherD5924
GA1744P3200XOtherS8095