=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265302582
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNA CHOS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2025
-----------------------------------------------------
Last Update Date | 11/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 795 POWDER SPRINGS ST
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30064-3689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-707-0304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 114 CRESCENT WOODE WAY
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30157-5711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-707-0304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | UZOAMAKA OKONKWO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-707-0304
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------