Healthcare Provider Details

I. General information

NPI: 1174416531
Provider Name (Legal Business Name): GENEVIEVE G. OBI-OSUALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 SLEEPY LN
WARNER ROBINS GA
31088-6764
US

IV. Provider business mailing address

335 SLEEPY LN
WARNER ROBINS GA
31088-6764
US

V. Phone/Fax

Practice location:
  • Phone: 478-955-1144
  • Fax: 478-955-1144
Mailing address:
  • Phone: 478-955-1144
  • Fax: 478-955-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN324050
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: