Provider Demographics
NPI:1255170502
Name:GLOBAL OUTREACH MEDICAL & BEHAVIOUR
Entity type:Organization
Organization Name:GLOBAL OUTREACH MEDICAL & BEHAVIOUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FOLASHADE
Authorized Official - Middle Name:TAIWO
Authorized Official - Last Name:UMOREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-309-4140
Mailing Address - Street 1:330 MICHIGAN CIR
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-5548
Mailing Address - Country:US
Mailing Address - Phone:770-309-4140
Mailing Address - Fax:
Practice Address - Street 1:330 MICHIGAN CIR
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-5548
Practice Address - Country:US
Practice Address - Phone:770-309-4140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty