Healthcare Provider Details

I. General information

NPI: 1699507715
Provider Name (Legal Business Name): ALPHAMEGA CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RIVULET DR
DALLAS GA
30132-9323
US

IV. Provider business mailing address

200 RIVULET DR
DALLAS GA
30132-9323
US

V. Phone/Fax

Practice location:
  • Phone: 470-461-3306
  • Fax: 770-763-7766
Mailing address:
  • Phone: 470-461-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: OLUMIDE JOLAYEMI
Title or Position: ADMINISTRATOR
Credential:
Phone: 470-461-3306