Healthcare Provider Details

I. General information

NPI: 1164916813
Provider Name (Legal Business Name): LENINA O CHI-UKPAI A-GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2018
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2942 SECRETARIAT CT
DECATUR GA
30034
US

IV. Provider business mailing address

2942 SECRETARIAT CT
DECATUR GA
30034-3452
US

V. Phone/Fax

Practice location:
  • Phone: 770-309-3489
  • Fax:
Mailing address:
  • Phone: 770-309-3489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN206960
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN206960
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: