Healthcare Provider Details

I. General information

NPI: 1215352851
Provider Name (Legal Business Name): JOAN OHAWA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2779 COBB PKWY NW
KENNESAW GA
30152-3437
US

IV. Provider business mailing address

2779 COBB PKWY NW
KENNESAW GA
30152-3437
US

V. Phone/Fax

Practice location:
  • Phone: 678-403-3983
  • Fax:
Mailing address:
  • Phone: 678-403-3983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN210195
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: