Provider Demographics
NPI:1578013751
Name:EPIPHANY HEALTHCARE SYSTEMS, INC
Entity Type:Organization
Organization Name:EPIPHANY HEALTHCARE SYSTEMS, INC
Other - Org Name:ACCESSIBLE HEALTHCARE OF SOUTH ATLANTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DICKSON
Authorized Official - Middle Name:
Authorized Official - Last Name:OSANU
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:770-306-3415
Mailing Address - Street 1:4405 MALL BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2044
Mailing Address - Country:US
Mailing Address - Phone:770-306-3416
Mailing Address - Fax:770-306-3417
Practice Address - Street 1:4405 MALL BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2044
Practice Address - Country:US
Practice Address - Phone:770-306-3416
Practice Address - Fax:770-306-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty