Healthcare Provider Details

I. General information

NPI: 1831951987
Provider Name (Legal Business Name): ASHLEY ABIEYUWA OKUNSERI CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 PEACHTREE PKWY STE 300
SUWANEE GA
30024-5901
US

IV. Provider business mailing address

2685 PEACHTREE PKWY STE 300
SUWANEE GA
30024-5901
US

V. Phone/Fax

Practice location:
  • Phone: 770-771-5270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberGAA-NP002233
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberGAA-CNM001997
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: