Organization
PROVIDENCE MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OLADAYO ADISA OSINUGA MD (PRESIDENT)
(404) 684-7111
Entity
Organization
Contact information
Practice address
550 PEACHTREE ST NE, SUITE 1285, ATLANTA, GA 30308-2249
(404) 856-3213
(404) 856-3217
Mailing address
PO BOX 4047, MACON, GA 31208-4047
(404) 856-3213
(404) 856-3217
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
051703
GA
Other
Enumeration date
12/05/2006
Last updated
06/19/2012
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