Organization
OMER L. EUBANKS MD, PC
Active
Other names
North Fulton Healthcare Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OMER L. EUBANKS M.D. (PRESIDENT)
(770) 740-1753
Entity
Organization
Contact information
Practice address
1155 HEMBREE RD, SUITE 210, ROSWELL, GA 30076-4622
(770) 740-1753
(770) 740-8503
Mailing address
1155 HEMBREE RD, SUITE 210, ROSWELL, GA 30076-4622
(770) 740-1753
(770) 740-8503
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
008430
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300028185B
—
GA
01
—
432850
WELLCARE
GA
01
—
CL3877
PALMETTO GBA - RAILROAD MEDICARE
GA
Enumeration date
11/28/2007
Last updated
01/28/2011
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