Individual
NIVIN OMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-5118
Mailing address
2315 MALONE WAY, EVANS, GA 30809-5313
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
12006
GA
Other
Enumeration date
06/15/2020
Last updated
06/15/2020
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