Healthcare Provider Details

I. General information

NPI: 1437753761
Provider Name (Legal Business Name): VINCENT UZOMA OHAYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2994 ATLANTA RD SE
SMYRNA GA
30080-3655
US

IV. Provider business mailing address

1603 BRIDGE MILL DR SE APT I
MARIETTA GA
30067-3852
US

V. Phone/Fax

Practice location:
  • Phone: 770-435-2178
  • Fax:
Mailing address:
  • Phone: 678-663-0135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number025937
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: