Provider Demographics
NPI:1518391952
Name:OMIC OF CORPORATION
Entity Type:Organization
Organization Name:OMIC OF CORPORATION
Other - Org Name:CHRISTIES HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OSARETIN
Authorized Official - Middle Name:FESTUS
Authorized Official - Last Name:ISIBOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-314-6244
Mailing Address - Street 1:3469 LAWRENCEVILLE HWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5866
Mailing Address - Country:US
Mailing Address - Phone:770-939-0143
Mailing Address - Fax:770-939-0145
Practice Address - Street 1:3469 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 303
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5866
Practice Address - Country:US
Practice Address - Phone:770-939-0143
Practice Address - Fax:770-939-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPAYEE#965934007AMedicaid