Provider Demographics
NPI:1619154499
Name:ATKINSON GROUP INC
Entity Type:Organization
Organization Name:ATKINSON GROUP INC
Other - Org Name:LIFELONGCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AKINSOLA
Authorized Official - Middle Name:KINGS
Authorized Official - Last Name:OJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-647-4510
Mailing Address - Street 1:1400 FARRINGTON WAY APT C
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-6075
Mailing Address - Country:US
Mailing Address - Phone:803-647-4510
Mailing Address - Fax:
Practice Address - Street 1:1400 FARRINGTON WAY APT C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-6075
Practice Address - Country:US
Practice Address - Phone:803-647-4510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD302F00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========Medicare Oscar/Certification