Provider Demographics
NPI:1740662063
Name:NOSA-OVIASU, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:NOSA-OVIASU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 SPANISH MOSS TRL
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6733
Mailing Address - Country:US
Mailing Address - Phone:617-785-6569
Mailing Address - Fax:
Practice Address - Street 1:2120 N SECTION ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-7518
Practice Address - Country:US
Practice Address - Phone:812-268-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH028384183500000X
MEPR5848183500000X
IN01097491A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No183500000XPharmacy Service ProvidersPharmacist