Provider Demographics
NPI:1043817992
Name:OGNOMY GA LLC
Entity type:Organization
Organization Name:OGNOMY GA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:MOROHUNFOLU
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINNUSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-878-2555
Mailing Address - Street 1:640 ELLICOTT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1252
Mailing Address - Country:US
Mailing Address - Phone:877-664-6669
Mailing Address - Fax:716-325-9094
Practice Address - Street 1:3750 PALLADIAN VILLAGE DR STE 110
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-8202
Practice Address - Country:US
Practice Address - Phone:678-878-2555
Practice Address - Fax:404-900-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty