Healthcare Provider Details

I. General information

NPI: 1083733794
Provider Name (Legal Business Name): MR. JOSEPH OWOHO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MESQUITE CT
MACON GA
31220-8334
US

IV. Provider business mailing address

100 MESQUITE CT
MACON GA
31220-8334
US

V. Phone/Fax

Practice location:
  • Phone: 478-757-0954
  • Fax: 478-457-2005
Mailing address:
  • Phone: 478-757-0954
  • Fax: 478-457-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT001733
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: