Healthcare Provider Details

I. General information

NPI: 1992919559
Provider Name (Legal Business Name): PETER OJURO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 CLINIC AVE STE 201
CARROLLTON GA
30117-4454
US

IV. Provider business mailing address

157 CLINIC AVE STE 201
CARROLLTON GA
30117-4454
US

V. Phone/Fax

Practice location:
  • Phone: 770-214-2800
  • Fax: 770-214-2803
Mailing address:
  • Phone: 770-214-2800
  • Fax: 770-214-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number71524
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number249390
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: