Healthcare Provider Details

I. General information

NPI: 1063069797
Provider Name (Legal Business Name): OMS URGENT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 ROSWELL RD STE 60
MARIETTA GA
30062-0819
US

IV. Provider business mailing address

2145 ROSWELL RD STE 60
MARIETTA GA
30062-0819
US

V. Phone/Fax

Practice location:
  • Phone: 248-390-0241
  • Fax:
Mailing address:
  • Phone: 770-672-6267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. OMOKHUALE OMOKHODION
Title or Position: PHYSICIAN
Credential: MD
Phone: 770-672-6267