Active NPI
Spatium Urgent Care LLC
- Urgent Care Clinic/Center
- Marietta, GA
National Provider Identifier
1508453044
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urgent Care Clinic/Center
- Legal business name
- SPATIUM URGENT CARE LLC
- Practice address
- 3595 Canton Rd Ste 316
Marietta, GA 30066-2693 - Phone
- (678) 932-2121
- NPI assigned
- Dec 30, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Aghogho Omene-Iroro, MD
- Title
- President
- Phone
- (443) 803-3372
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urgent Care Clinic/Center | 261QU0200X | Primary |
Addresses
Primary practice location
3595 Canton Rd Ste 316
Marietta, GA 30066-2693
Mailing address
3595 Canton Rd Ste 17
Marietta, GA 30066-2658
Phone (770) 820-1290
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210304001611 | GA | Part B Supplier - Clinic/Group Practice | 5294141941 |
Receives reassigned benefits from 5 practitioners Practice locations: Marietta, GA |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2215004 | Spatium Urgent Care | Certificate of waiver | Feb 25, 2027 |
National Provider Directory
National Provider DirectoryLocations
3595 Canton Rd
Ste 316
Marietta, GA 30066
Phone (678) 932-2121
Practitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Atlanta, GA
- NPI 1306349097
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609286400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1697587200000",
"number": "1508453044",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3595 CANTON RD STE 17",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300662658",
"telephone_number": "770-820-1290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3595 CANTON RD STE 316",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300662693",
"telephone_number": "678-932-2121"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SPATIUM URGENT CARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-12-30",
"last_updated": "2023-10-18",
"certification_date": "2023-10-18",
"status": "A",
"authorized_official_last_name": "OMENE-IRORO",
"authorized_official_first_name": "AGHOGHO",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "443-803-3372",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "261QU0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Urgent Care",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.