Healthcare Provider Details

I. General information

NPI: 1235729773
Provider Name (Legal Business Name): OGHENETEGIRI UREVBU APRN GAA- NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/20/2021
Certification Date: 01/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PHILLIP'S PEDIATRICS, PC 455 S MAIN STREET, STE 103
HINESVILLE GA
31313
US

IV. Provider business mailing address

PHILLIP'S PEDIATRICS, PC 455 S MAIN STREET, STE 103
HINESVILLE GA
31313
US

V. Phone/Fax

Practice location:
  • Phone: 912-876-6868
  • Fax: 912-876-6566
Mailing address:
  • Phone: 912-876-6868
  • Fax: 912-876-6566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NP000025
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: