Healthcare Provider Details

I. General information

NPI: 1578983979
Provider Name (Legal Business Name): NGOZI GLORIA OKORO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2733 LOST LAKES DR
POWDER SPRINGS GA
30127-6012
US

IV. Provider business mailing address

2733 LOST LAKES DR
POWDER SPRINGS GA
30127-6012
US

V. Phone/Fax

Practice location:
  • Phone: 678-361-0116
  • Fax:
Mailing address:
  • Phone: 678-361-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN149536
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: