Provider Demographics
NPI:1407926207
Name:ULTIMATE HEALTH SERVICES
Entity Type:Organization
Organization Name:ULTIMATE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR.
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYODE
Authorized Official - Middle Name:
Authorized Official - Last Name:FASAE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-761-6009
Mailing Address - Street 1:4854 OLD NATIONAL HWY
Mailing Address - Street 2:SUITE 236
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30337-6221
Mailing Address - Country:US
Mailing Address - Phone:404-761-6009
Mailing Address - Fax:404-761-6553
Practice Address - Street 1:4854 OLD NATIONAL HWY
Practice Address - Street 2:SUITE 236
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-6221
Practice Address - Country:US
Practice Address - Phone:404-761-6009
Practice Address - Fax:404-761-6553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-0027251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care