Provider Demographics
NPI:1801251202
Name:PRIME VERITAS
Entity type:Organization
Organization Name:PRIME VERITAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLAWUNMI
Authorized Official - Middle Name:YETUNDE
Authorized Official - Last Name:OGUN-SEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:770-895-3787
Mailing Address - Street 1:1889 TRINITY MILL DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1015
Mailing Address - Country:US
Mailing Address - Phone:770-895-3787
Mailing Address - Fax:
Practice Address - Street 1:1889 TRINITY MILL DR
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1015
Practice Address - Country:US
Practice Address - Phone:770-895-3787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========2Medicare UPIN