Provider Demographics
NPI:1659691681
Name:IJB HEALTHCARE SERVICES, PC
Entity Type:Organization
Organization Name:IJB HEALTHCARE SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUGBEMIGA
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSOBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-331-8035
Mailing Address - Street 1:4780A ASHFORD DUNWOODY RD
Mailing Address - Street 2:SUITE 621
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5504
Mailing Address - Country:US
Mailing Address - Phone:770-331-8035
Mailing Address - Fax:770-458-1596
Practice Address - Street 1:4780A ASHFORD DUNWOODY RD
Practice Address - Street 2:SUITE 621
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5504
Practice Address - Country:US
Practice Address - Phone:770-331-8035
Practice Address - Fax:770-458-1596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0593002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty