Healthcare Provider Details

I. General information

NPI: 1851087829
Provider Name (Legal Business Name): MAUREEN OGECHUKWU ONYIMA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3995 S COBB DR SE
SMYRNA GA
30080-6397
US

IV. Provider business mailing address

8743 HAMIL CT
DOUGLASVILLE GA
30135-7550
US

V. Phone/Fax

Practice location:
  • Phone: 404-200-7259
  • Fax:
Mailing address:
  • Phone: 404-200-7259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberRN284894
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: