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General NPI Number Information
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NPI Number | 1144674581
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Entity Type | Individual
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Provider Name | RALPH OGWOTU
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Gender | Male
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Dates
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Enumeration Date | 04/22/2016
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 6572 RIVER PARK DR STE 101
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City | RIVERDALE
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State | GA
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Zip | 30274-2214
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Country | US
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Telephone | 404-514-3498
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Fax |
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Provider Business Mailing Address
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Address Line | 110 W PIER WAY
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-4617
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Country | US
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Telephone | 404-514-3498
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 233148
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN233148
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License Number State | GA
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