=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568718450
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOY CHINENYENWA ONWUSIBE NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2012
-----------------------------------------------------
Last Update Date | 07/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 W MEMORIAL DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30132-4117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-445-4411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2318 MAGAW LN
-----------------------------------------------------
City | POWDER SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30127-5629
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-222-7075
-----------------------------------------------------
Fax | 770-222-7035
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | RN162813
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------