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General NPI Number Information
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NPI Number | 1356363287
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Entity Type | Organization
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Legal Business Name | OMNI HEALTH SOLUTIONS LLC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 841 MULBERRY ST
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City | MACON
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State | GA
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Zip | 31201-6756
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Country | US
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Telephone | 478-741-6554
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Fax | 478-743-7052
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Provider Business Mailing Address
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Address Line | 841 MULBERRY ST
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City | MACON
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State | GA
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Zip | 31201-6756
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Country | US
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Telephone | 478-741-6554
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Fax | 478-743-5052
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. CLYDE O. GREEN
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Credential | MD
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Telephone | 478-743-7805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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