Healthcare Provider Details

I. General information

NPI: 1386415933
Provider Name (Legal Business Name): CHINYEAKA LINDA OGBONNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHINYEAKA LINDA IHEANACHO PMHNP

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3682 PEBBLE STREET
STONECREST GA
30038
US

IV. Provider business mailing address

3682 PEBBLE STREET
STONECREST GA
30038
US

V. Phone/Fax

Practice location:
  • Phone: 404-384-3044
  • Fax:
Mailing address:
  • Phone: 404-384-3044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN284124
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: