Healthcare Provider Details

I. General information

NPI: 1619208717
Provider Name (Legal Business Name): GRACE ISOKEN OGALA N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE ISOKEN OGALA N.P

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 AUSTIN GRAYBILL RD
NORTH AUGUSTA SC
29860
US

IV. Provider business mailing address

2030 POWERS FERRY RD SE STE 120
ATLANTA GA
30339-5016
US

V. Phone/Fax

Practice location:
  • Phone: 803-278-4272
  • Fax:
Mailing address:
  • Phone: 678-801-2329
  • Fax: 844-249-2637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN252611
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: