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General NPI Number Information
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NPI Number | 1679245617
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Entity Type | Individual
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Provider Name | CHIZOBA CLARA AZALAM
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Gender | Female
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 03/17/2026
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Provider Practice Location Address
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Address Line | 2089 ALCOVY SHOALS BLF
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-2787
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Country | US
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Telephone | 248-245-4988
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Fax |
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Provider Business Mailing Address
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Address Line | 1737 WINBURY DR
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City | MIDLOTHIAN
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State | VA
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Zip | 23114-5147
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Country | US
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Telephone | 248-245-4988
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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 | 0001293182
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License Number State | VA
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