Omega Physician Practice LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

OMEGA PHYSICIAN PRACTICE LLC

Practice address

1300 Ridenour Blvd NW
Kennesaw, GA 30152-4501

Phone

(770) 702-1806

NPI assigned

Apr 7, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Rudolph Davis, MD MPHNPI 1275038408

Title

Anesthesiologist

Phone

(205) 317-8437

Specialties & licenses 1

Addresses

Electronic endpoints 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rudolph Alexander Davis, MD, MPH

  • Anesthesiology Physician
  • Atlanta, GA
  • NPI 1275038408
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649289600000",
    "number": "1013658467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3927 CONCORD WALK DR SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300823659",
            "telephone_number": "205-317-8437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 RIDENOUR BLVD NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301524501",
            "telephone_number": "770-702-1806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMEGA PHYSICIAN PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-07",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "RUDOLPH",
        "authorized_official_title_or_position": "ANESTHESIOLOGIST",
        "authorized_official_telephone_number": "205-317-8437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD MPH"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.makanesthesia.com/",
            "affiliation": "N",
            "address_1": "1300 Ridenour Blvd NW",
            "city": "Kennesaw",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301524501",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Anesthesiology Physician in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Anesthesiology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.