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General NPI Number Information
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NPI Number | 1366795973
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Entity Type | Organization
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Legal Business Name | MERIDIAN INTERNAL MEDICINE AND PRIMARY CARE INC
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 11/14/2012
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Provider Practice Location Address
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Address Line | 3890 REDWINE RD SW STE 210
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City | ATLANTA
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State | GA
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Zip | 30331-5583
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Country | US
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Telephone | 404-691-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 1029 N PEACHTREE PKWY STE 376
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-4210
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Country | US
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Telephone | 404-691-6688
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | DR. KAY OLUKAYODE OSO
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Credential | MD
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Telephone | 678-485-5705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 044049
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License Number State | GA
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