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General NPI Number Information
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NPI Number | 1578013751
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Entity Type | Organization
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Legal Business Name | EPIPHANY HEALTHCARE SYSTEMS, INC
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 4405 MALL BLVD SUITE 315
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City | UNION CITY
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State | GA
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Zip | 30291-2044
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Country | US
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Telephone | 770-306-3416
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Fax | 770-306-3417
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Provider Business Mailing Address
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Address Line | 4405 MALL BLVD SUITE 315
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City | UNION CITY
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State | GA
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Zip | 30291-2044
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Country | US
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Telephone | 770-306-3416
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Fax | 770-306-3417
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Authorized Official
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Title or Position | CEO
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Name | DICKSON OSANU
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Credential | RN, MBA
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Telephone | 770-306-3415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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