Provider Demographics
NPI:1922679851
Name:OLYMPUSMD PAIN AND WELLNESS SPECIALISTS
Entity Type:Organization
Organization Name:OLYMPUSMD PAIN AND WELLNESS SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EFOSA
Authorized Official - Middle Name:OMONWUA
Authorized Official - Last Name:OGIAMIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-613-8250
Mailing Address - Street 1:1081 VININGS FALLS DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-5894
Mailing Address - Country:US
Mailing Address - Phone:770-365-9622
Mailing Address - Fax:
Practice Address - Street 1:1370 MONTREAL RD STE 130
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8128
Practice Address - Country:US
Practice Address - Phone:678-408-0664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty