NPIMap

Organization Active NPI

Omega Family Medicine, LLC

  • Family Medicine Physician
  • Omega, GA
National Provider Identifier
1184021933
Registry record updated Nov 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
OMEGA FAMILY MEDICINE, LLC
Practice address
130 Moore St
Omega, GA 31775-3075
Phone
(229) 528-6500
NPI assigned
Nov 21, 2014
Last updated
Nov 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2014

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

Authorized official

Name
Dr. Richard Anthony Ambrozic, M.D.
Title
Owner/President
Phone
(229) 528-6500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

130 Moore St
Omega, GA 31775-3075

Mailing address

4741 Blackwater Dr
Valdosta, GA 31602-4983

National Provider Directory

National Provider Directory

Locations

130 Moore St
Omega, GA 31775
Phone (229) 528-6500

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1416528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416528000000",
    "number": "1184021933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4741 BLACKWATER DR",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316024983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 MOORE ST",
            "city": "OMEGA",
            "state": "GA",
            "postal_code": "317753075",
            "telephone_number": "229-528-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMEGA FAMILY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-21",
        "last_updated": "2014-11-21",
        "status": "A",
        "authorized_official_last_name": "AMBROZIC",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "229-528-6500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omega, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2014; 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.