Healthcare Provider Details

I. General information

NPI: 1447869482
Provider Name (Legal Business Name): ONYINYE ADAORA UKADIKE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2994 ATLANTA RD SE
SMYRNA GA
30080-3655
US

IV. Provider business mailing address

2994 ATLANTA RD SE
SMYRNA GA
30080-3655
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN226003
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: