Healthcare Provider Details

I. General information

NPI: 1386247476
Provider Name (Legal Business Name): JACQUELINE ONOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 BOULEVARD SE
ATLANTA GA
30312-3428
US

IV. Provider business mailing address

103 JESSE JEWELL PKWY SW
GAINESVILLE GA
30501-4321
US

V. Phone/Fax

Practice location:
  • Phone: 404-624-0022
  • Fax:
Mailing address:
  • Phone: 770-536-3441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH024060
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: