Provider Demographics
NPI:1023186384
Name:EAST POINT PRIMARY CARE CENTER, PC
Entity Type:Organization
Organization Name:EAST POINT PRIMARY CARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLADAYO
Authorized Official - Middle Name:ADISA
Authorized Official - Last Name:OSINUGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-684-7111
Mailing Address - Street 1:1203 CLEVELAND AVE
Mailing Address - Street 2:SUITE 2-D
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3417
Mailing Address - Country:US
Mailing Address - Phone:404-684-7111
Mailing Address - Fax:404-684-7112
Practice Address - Street 1:1203 CLEVELAND AVE
Practice Address - Street 2:SUITE 2-D
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3417
Practice Address - Country:US
Practice Address - Phone:404-684-7111
Practice Address - Fax:404-684-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051703207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6808Medicare ID - Type UnspecifiedMEDICARE GROUP ID NUMBER
GAH62947Medicare UPIN
GA93BBJBTMedicare ID - Type Unspecified