Provider Demographics
NPI:1508453044
Name:SPATIUM URGENT CARE LLC
Entity Type:Organization
Organization Name:SPATIUM URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AGHOGHO
Authorized Official - Middle Name:
Authorized Official - Last Name:OMENE-IRORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-803-3372
Mailing Address - Street 1:3595 CANTON RD STE 17
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2658
Mailing Address - Country:US
Mailing Address - Phone:770-820-1290
Mailing Address - Fax:
Practice Address - Street 1:3595 CANTON RD STE 316
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2693
Practice Address - Country:US
Practice Address - Phone:678-932-2121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care