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General NPI Number Information
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NPI Number | 1003530916
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Entity Type | Organization
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Legal Business Name | EASYLIFE
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 1604 ZACHARYS WAY
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City | MCDONOUGH
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State | GA
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Zip | 30253-9024
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Country | US
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Telephone | 678-499-0105
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Fax |
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Provider Business Mailing Address
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Address Line | 1659 HIGHWAY 20 W STE 204
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City | MCDONOUGH
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State | GA
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Zip | 30253-7311
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Country | US
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Telephone | 678-499-0105
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHIDIEBERE OSONDU
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Credential | PMHNP
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Telephone | 678-499-0105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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