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General NPI Number Information
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NPI Number | 1255902516
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Entity Type | Organization
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Legal Business Name | OMI OF GADSDEN PETCT LLC
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 1026 GOODYEAR AVE STE 50
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City | GADSDEN
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State | AL
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Zip | 35903-1101
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Country | US
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Telephone | 256-546-7507
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Fax | 256-492-8345
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Provider Business Mailing Address
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Address Line | 1026 GOODYEAR AVE STE 50
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City | GADSDEN
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State | AL
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Zip | 35903-1101
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Country | US
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Telephone | 256-546-7507
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Fax | 256-492-8345
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Authorized Official
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Title or Position | TREASURER
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Name | TAMMY WOMACK HOBBS
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Credential |
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Telephone | 484-679-4455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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