Healthcare Provider Details

I. General information

NPI: 1356822126
Provider Name (Legal Business Name): GLORY DIOH-ESONA DNP, NP-C, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 MEMORIAL DR STE G
DECATUR GA
30032-2706
US

IV. Provider business mailing address

2340 DEESIDE SE
CONYERS GA
30013-6470
US

V. Phone/Fax

Practice location:
  • Phone: 404-494-6774
  • Fax:
Mailing address:
  • Phone: 404-494-6774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN240522
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN240522
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: