Healthcare Provider Details

I. General information

NPI: 1457867475
Provider Name (Legal Business Name): EUCHARIA UDOKA OBI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9051 JENNI CIR
JONESBORO GA
30238-6800
US

IV. Provider business mailing address

9051 JENNI CIR
JONESBORO GA
30238-6800
US

V. Phone/Fax

Practice location:
  • Phone: 404-964-0882
  • Fax:
Mailing address:
  • Phone: 404-964-0882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN196330
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: