Healthcare Provider Details

I. General information

NPI: 1841491032
Provider Name (Legal Business Name): KAREN UYESUGI CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 HIGHWAY 54 W SUITE 220
FAYETTEVILLE GA
30214-4550
US

IV. Provider business mailing address

1046 RIDGE AVE SW SUITE 220
ATLANTA GA
30315-1640
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-2200
  • Fax: 770-991-1341
Mailing address:
  • Phone: 404-688-1350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberRN090354
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: