Individual
MR. OMAR S GANZY SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
600 CELEBRATE LIFE PKWY, NEWNAN, GA 30265-8001
(850) 264-3477
Mailing address
600 CELEBRATE LIFE PKWY, NEWNAN, GA 30265-8001
(850) 264-3477
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN157958
GA
363LA2200X
Adult Health Nurse Practitioner
RN157958
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN157958
GEORGIA NURSING LICENSE
GA
Enumeration date
12/09/2019
Last updated
06/27/2021
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