Healthcare Provider Details

I. General information

NPI: 1013631324
Provider Name (Legal Business Name): LINDA ESOSA UWAKWE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5215 CORBIN CT
SUWANEE GA
30024-3396
US

IV. Provider business mailing address

5215 CORBIN CT
SUWANEE GA
30024-3396
US

V. Phone/Fax

Practice location:
  • Phone: 404-567-9442
  • Fax:
Mailing address:
  • Phone: 404-567-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN168828
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: