Healthcare Provider Details

I. General information

NPI: 1629669163
Provider Name (Legal Business Name): JUDE C OHAYA PHARMD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 FOREST PKWY STE A
FOREST PARK GA
30297-2165
US

IV. Provider business mailing address

381 FOREST PKWY STE A
FOREST PARK GA
30297-2165
US

V. Phone/Fax

Practice location:
  • Phone: 404-366-9088
  • Fax: 404-366-8982
Mailing address:
  • Phone: 404-366-9088
  • Fax: 404-366-8982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15394
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: