Healthcare Provider Details

I. General information

NPI: 1285073148
Provider Name (Legal Business Name): CHERRI DENISE ESEZOBOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 FRANKLIN GTWY SE
MARIETTA GA
30067-8721
US

IV. Provider business mailing address

1405 FRANKLIN GTWY SE
MARIETTA GA
30067-8721
US

V. Phone/Fax

Practice location:
  • Phone: 770-951-5400
  • Fax: 678-388-1399
Mailing address:
  • Phone: 770-951-5400
  • Fax: 678-388-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN128018
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: