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General NPI Number Information
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NPI Number | 1578110706
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Entity Type | Organization
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Legal Business Name | FIRST PLUS MEDICAL LLC
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 3327 HIGHWAY 5
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-2307
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Country | US
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Telephone | 678-999-7784
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Fax |
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Provider Business Mailing Address
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Address Line | 5775 JIMMY CARTER BLVD
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City | NORCROSS
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State | GA
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Zip | 30071-2989
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. VICTOR OSISANYA
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Credential |
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Telephone | 404-493-0138
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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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