MEDICARE: ANNA OMACHONU

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	104100000X	Social Worker	MSW006035	GA

General Provider Information

NPI Number	:	1861826208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA OMACHONU

Provider Business Mailing Address
First Line	:	378 TABOR RD
Second Line	:
City	:	FORT VALLEY
State	:	GA
Zip	:	31030-6024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	378 TABOR RD
Second Line	:
City	:	FORT VALLEY
State	:	GA
Zip	:	31030-6024
Country	:	US
Telephone Number	:	478-971-4684
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/21/2013

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Directions to “ ANNA OMACHONU ” Practice Location

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