Healthcare Provider Details

I. General information

NPI: 1497083885
Provider Name (Legal Business Name): OMNI SURGICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8409 DUNWOODY PL
ATLANTA GA
30350-3367
US

IV. Provider business mailing address

8409 DUNWOODY PL
ATLANTA GA
30350-3367
US

V. Phone/Fax

Practice location:
  • Phone: 770-594-1351
  • Fax: 770-594-1381
Mailing address:
  • Phone: 770-594-1351
  • Fax: 770-594-1381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH ARTHUR
Title or Position: C.S.A
Credential:
Phone: 770-594-1351