Provider Demographics
NPI:1346864592
Name:OMEGA GENOMIX, LLC
Entity Type:Organization
Organization Name:OMEGA GENOMIX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYDOUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-212-4649
Mailing Address - Street 1:200 WASHINGTON ST NW STE C
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3622
Mailing Address - Country:US
Mailing Address - Phone:678-696-8867
Mailing Address - Fax:
Practice Address - Street 1:200 WASHINGTON ST NW STE C
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3622
Practice Address - Country:US
Practice Address - Phone:678-696-8867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory