Healthcare Provider Details

I. General information

NPI: 1013744101
Provider Name (Legal Business Name): OMNIPRESENCE CARE MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4485 LAWRENCEVILLE HWY. NW. STE. 207 #3383
LILBURN GA
30047
US

IV. Provider business mailing address

4485 LAWRENCEVILLE HWY. NW. STE. 207 #3383
LILBURN GA
30047
US

V. Phone/Fax

Practice location:
  • Phone: 404-981-3863
  • Fax:
Mailing address:
  • Phone: 404-981-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. KARLISHIA MORRIS
Title or Position: CEO
Credential:
Phone: 404-981-3863