Healthcare Provider Details

I. General information

NPI: 1578471306
Provider Name (Legal Business Name): OBIANUJU OKPONYIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5815 CAMPBELLTON RD SW
ATLANTA GA
30331-8046
US

IV. Provider business mailing address

4418 GEORGE DAVID WAY
POWDER SPRINGS GA
30127-2246
US

V. Phone/Fax

Practice location:
  • Phone: 404-346-4164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH036295
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: