Healthcare Provider Details

I. General information

NPI: 1982008587
Provider Name (Legal Business Name): NAOMI OBIALOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 PRIMROSE HILL CT
NORCROSS GA
30092-4544
US

IV. Provider business mailing address

6330 PRIMROSE HILL CT
NORCROSS GA
30092-4544
US

V. Phone/Fax

Practice location:
  • Phone: 770-903-0120
  • Fax: 770-903-0141
Mailing address:
  • Phone: 770-962-6443
  • Fax: 770-962-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number206149
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: