MEDICARE: OM HEALTHCARE 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1902622137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OM HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	5805 STATE BRIDGE RD STE G439
Second Line	:
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-8220
Country	:	US
Telephone Number	:	706-681-0155
Fax Number	:

Provider Business Practice Location Address
First Line	:	1083 PARKWAY BLVD
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-6171
Country	:	US
Telephone Number	:	347-458-7445
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	KUSHAL PATEL
Credential	:	MD
Telephone Number	:	219-230-2091

Provider Enumeration Date	:	12/03/2024
Last Update Date	:	03/02/2026

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Directions to “OM HEALTHCARE LLC ” Practice Location

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