Provider Demographics
NPI:1174040422
Name:ONYX HEALTH AND WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ONYX HEALTH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEREMI
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-300-8489
Mailing Address - Street 1:108 W HILL AVE
Mailing Address - Street 2:STE B
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1802
Practice Address - Country:US
Practice Address - Phone:229-375-2522
Practice Address - Fax:229-329-4140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care