Healthcare Provider Details

I. General information

NPI: 1891266466
Provider Name (Legal Business Name): GLOFUSION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 03/10/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 WILLIAMSON RD STE 101
GRIFFIN GA
30224-5471
US

IV. Provider business mailing address

1705 WILLIAMSON RD STE 101
GRIFFIN GA
30224-5471
US

V. Phone/Fax

Practice location:
  • Phone: 404-218-8934
  • Fax: 678-603-2086
Mailing address:
  • Phone: 678-603-2898
  • Fax: 678-603-2086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ONYEBUCHI NWAOKOLO
Title or Position: NP
Credential: DNP
Phone: 678-603-2898