Healthcare Provider Details

I. General information

NPI: 1508121625
Provider Name (Legal Business Name): OHM CLINICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100B ROSWELL RD 400
ATLANTA GA
30350-6428
US

IV. Provider business mailing address

8100B ROSWELL RD 400
ATLANTA GA
30350-6428
US

V. Phone/Fax

Practice location:
  • Phone: 404-865-1228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSIAH HAWKINS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 678-926-8599