Healthcare Provider Details

I. General information

NPI: 1942171368
Provider Name (Legal Business Name): OMAHA ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 JIMMY CARTER BLVD STE 1220-C
NORCROSS GA
30071-1228
US

IV. Provider business mailing address

6825 JIMMY CARTER BLVD STE 1220-C
NORCROSS GA
30071-1228
US

V. Phone/Fax

Practice location:
  • Phone: 678-360-0873
  • Fax:
Mailing address:
  • Phone: 678-360-0873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: HARICHARAN TEJA MADDURI
Title or Position: PRESIDENT
Credential:
Phone: 678-360-0873