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NPI Code Detail

MEDICARE: VERONICA IKONGE GICHANA NP

MEDICARE:   VERONICA IKONGE GICHANA  NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianRN225597GA
2363LP0808XPsychiatric/Mental Health Nurse PractitionerRN225597GA

General Provider Information

NPI Number : 1477296739
Entity Type Code : Individual
Provider Name (Legal Business Name) : VERONICA IKONGE GICHANA NP
Provider Business Mailing Address
First Line : 280 NAVARRE DR
Second Line :
City : FAYETTEVILLE
State : GA
Zip : 30214-4176
Country : US
Telephone Number : 678-709-3728
Fax Number :
Provider Business Practice Location Address
First Line : 1700 MEDICAL WAY
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-2195
Country : US
Telephone Number : 478-464-8134
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2022
Last Update Date : 05/11/2023

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