Provider Demographics
NPI:1508538224
Name:OSMANOVIC, DEMIR (NP)
Entity Type:Individual
Prefix:
First Name:DEMIR
Middle Name:
Last Name:OSMANOVIC
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 KEITH AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-1811
Mailing Address - Country:US
Mailing Address - Phone:678-920-0867
Mailing Address - Fax:
Practice Address - Street 1:270 CARPENTER DR STE 400
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4933
Practice Address - Country:US
Practice Address - Phone:678-460-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN.25135363L00000X
GARN277778363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner