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General NPI Number Information
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NPI Number | 1003490764
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Entity Type | Individual
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Provider Name | GLORY OSADIAYE PMHNP, MSN, BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 06/11/2023
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Provider Practice Location Address
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Address Line | 250 CONSTITUTION BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8432
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Country | US
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Telephone | 470-844-0157
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Fax | 678-539-8899
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Provider Business Mailing Address
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Address Line | 250 CONSTITUTION BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8432
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Country | US
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Telephone | 470-844-0157
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN250999
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | RN250999
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 163WH1000X
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Taxonomy Name | Hospice Registered Nurse
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License Number | RN250999
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN250999
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN250999
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License Number State | GA
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN250999
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 250999
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License Number State | GA
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