MEDICARE: OSCAR MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	039650	GA
2	261QX0100X	Occupational Medicine Clinic/Center	039650	GA
3	261QU0200X	Urgent Care Clinic/Center	039650	GA

General Provider Information

NPI Number	:	1871901694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSCAR MEDICAL CENTER

Provider Business Mailing Address
First Line	:	3055 OAK HAMPTON WAY
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-5855
Country	:	US
Telephone Number	:	470-355-2340
Fax Number	:	470-355-2347

Provider Business Practice Location Address
First Line	:	3375 MEMORIAL DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-2706
Country	:	US
Telephone Number	:	470-355-2340
Fax Number	:	470-355-2347

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. IGWEBUIKE ONYEKABA
Credential	:	MD
Telephone Number	:	470-355-2340

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	07/14/2015

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Directions to “OSCAR MEDICAL CENTER ” Practice Location

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