Organization
ACCESSIBLE WALK-IN CLINIC
Active
Organization
ACCESSIBLE WALK-IN CLINIC
Active
Parent organization
EPIPHANY HEALTHCARE SYSTEM, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
EPIPHANY HEALTHCARE SYSTEM, INC
Authorized official
DICKSON OSANU (CEO)
(404) 226-9131
Entity
Organization
Contact information
Practice address
1206 J W DAVIS DR STE 102, HAMMOND, LA 70403-5953
(985) 956-7370
(985) 956-7371
Mailing address
1206 J W DAVIS DR STE 102, HAMMOND, LA 70403-5953
(985) 956-7370
(985) 956-7371
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1124202973
HOME CARE
GA
05
—
1124202973
—
GA
Enumeration date
12/06/2018
Last updated
12/06/2018
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