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General NPI Number Information
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NPI Number | 1770077083
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Entity Type | Individual
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Provider Name | MICHAEL BRANDON OMAR MD/MBBS
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Gender | Male
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 3025 SHRINE RD STE 290
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City | BRUNSWICK
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State | GA
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Zip | 31520-4785
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Country | US
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Telephone | 912-466-7660
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Fax | 912-264-1526
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Provider Business Mailing Address
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Address Line | PO BOX 1213
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City | BRUNSWICK
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State | GA
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Zip | 31521-1213
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Country | US
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Telephone | 912-466-5000
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Fax | 912-466-5013
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 98042
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License Number State | GA
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