Healthcare Provider Details

I. General information

NPI: 1669396826
Provider Name (Legal Business Name): PEACE OMOWONUOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 WHITLOCK PL SW STE 100
MARIETTA GA
30064-3155
US

IV. Provider business mailing address

70 WHITLOCK PL SW STE 100
MARIETTA GA
30064-3155
US

V. Phone/Fax

Practice location:
  • Phone: 470-604-9800
  • Fax: 470-604-9900
Mailing address:
  • Phone: 470-604-9800
  • Fax: 470-604-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP712244
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: