Provider Demographics
NPI:1184021933
Name:OMEGA FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:OMEGA FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:AMBROZIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-528-6500
Mailing Address - Street 1:4741 BLACKWATER DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-4983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 MOORE ST
Practice Address - Street 2:
Practice Address - City:OMEGA
Practice Address - State:GA
Practice Address - Zip Code:31775-3075
Practice Address - Country:US
Practice Address - Phone:229-528-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty