Healthcare Provider Details

I. General information

NPI: 1598553471
Provider Name (Legal Business Name): OBA SOCIAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5940 ROXBORO CT
CUMMING GA
30040-8860
US

IV. Provider business mailing address

5940 ROXBORO CT
CUMMING GA
30040-8860
US

V. Phone/Fax

Practice location:
  • Phone: 678-858-1905
  • Fax:
Mailing address:
  • Phone: 678-858-1905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: OMOLARA ANNE OBAHIAGBON
Title or Position: OWNER
Credential: ADMINISTRATOR
Phone: 678-858-1905