Healthcare Provider Details

I. General information

NPI: 1952279234
Provider Name (Legal Business Name): CELINE EVBUOMWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1874 PIEDMONT AVE NE STE 100A
ATLANTA GA
30324-4816
US

IV. Provider business mailing address

1874 PIEDMONT AVE NE STE 100A
ATLANTA GA
30324-4816
US

V. Phone/Fax

Practice location:
  • Phone: 404-733-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH035917
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: