Healthcare Provider Details

I. General information

NPI: 1184411167
Provider Name (Legal Business Name): LISA ONOKALAH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 SIXES RD
CANTON GA
30114-9102
US

IV. Provider business mailing address

3290 SIXES RD
CANTON GA
30114-9102
US

V. Phone/Fax

Practice location:
  • Phone: 770-914-0116
  • Fax:
Mailing address:
  • Phone: 404-496-1955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN290015
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: