Healthcare Provider Details

I. General information

NPI: 1023186384
Provider Name (Legal Business Name): EAST POINT PRIMARY CARE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 CLEVELAND AVE SUITE 2-D
EAST POINT GA
30344-3417
US

IV. Provider business mailing address

1203 CLEVELAND AVE SUITE 2-D
EAST POINT GA
30344-3417
US

V. Phone/Fax

Practice location:
  • Phone: 404-684-7111
  • Fax: 404-684-7112
Mailing address:
  • Phone: 404-684-7111
  • Fax: 404-684-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number051703
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number051703
License Number StateGA

VIII. Authorized Official

Name: DR. OLADAYO ADISA OSINUGA
Title or Position: PRESIDENT
Credential: MD
Phone: 404-684-7111