Healthcare Provider Details

I. General information

NPI: 1407749211
Provider Name (Legal Business Name): CHRISTIANA ASARE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 WILD BARLEY WAY
LOGANVILLE GA
30052-8223
US

IV. Provider business mailing address

255 WILD BARLEY WAY
LOGANVILLE GA
30052-8223
US

V. Phone/Fax

Practice location:
  • Phone: 404-542-2014
  • Fax:
Mailing address:
  • Phone: 404-542-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN281352
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberRN281352
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: