Provider Demographics
NPI:1306399936
Name:DICKSON OSANU
Entity Type:Organization
Organization Name:DICKSON OSANU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DICKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:OSANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-226-9131
Mailing Address - Street 1:4405 MALL BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2070
Mailing Address - Country:US
Mailing Address - Phone:404-226-9131
Mailing Address - Fax:
Practice Address - Street 1:4405 MALL BLVD STE 315
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2070
Practice Address - Country:US
Practice Address - Phone:404-226-9131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN1085123140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric