MEDICARE: MERIDIAN INTERNAL MEDICINE AND PRIMARY CARE INC

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	207R00000X	Internal Medicine Physician	044049	GA

General Provider Information

NPI Number	:	1366795973
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN INTERNAL MEDICINE AND PRIMARY CARE INC

Provider Business Mailing Address
First Line	:	1029 N PEACHTREE PKWY STE 376
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-4210
Country	:	US
Telephone Number	:	404-691-6688
Fax Number	:

Provider Business Practice Location Address
First Line	:	3890 REDWINE RD SW STE 210
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-5583
Country	:	US
Telephone Number	:	404-691-6688
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	DR. KAY OLUKAYODE OSO
Credential	:	MD
Telephone Number	:	678-485-5705

Provider Enumeration Date	:	10/19/2012
Last Update Date	:	11/14/2012

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