MEDICARE: OGNOMY GA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0012X	Sleep Medicine (Internal Medicine) Physician

General Provider Information

NPI Number	:	1043817992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OGNOMY GA LLC

Provider Business Mailing Address
First Line	:	640 ELLICOTT ST STE 101
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14203-1252
Country	:	US
Telephone Number	:	877-664-6669
Fax Number	:	716-325-9094

Provider Business Practice Location Address
First Line	:	3750 PALLADIAN VILLAGE DR STE 110
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-8202
Country	:	US
Telephone Number	:	678-878-2555
Fax Number	:	404-900-9055

Authorized Official
Title or Position	:	ORGANIZER
Name	:	MOROHUNFOLU AKINNUSI
Credential	:	MD
Telephone Number	:	678-878-2555

Provider Enumeration Date	:	10/05/2020
Last Update Date	:	08/08/2023

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Directions to “OGNOMY GA LLC ” Practice Location

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