Provider Demographics
NPI:1750194023
Name:OMNIMED DME INC
Entity type:Organization
Organization Name:OMNIMED DME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-446-9373
Mailing Address - Street 1:2959 CHEROKEE ST NW STE 103-C
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6521
Mailing Address - Country:US
Mailing Address - Phone:404-446-9373
Mailing Address - Fax:404-868-5982
Practice Address - Street 1:2959 CHEROKEE ST NW STE 103C
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6522
Practice Address - Country:US
Practice Address - Phone:404-446-9373
Practice Address - Fax:404-868-5982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies