MEDICARE: VIVIEN CHIJIOKE OPURUM RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	RN203681	GA
2	163W00000X	Registered Nurse	RN203681	GA

General Provider Information

NPI Number	:	1295679579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIEN CHIJIOKE OPURUM RN

Provider Business Mailing Address
First Line	:	2799 DELK RD SE STE 150
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-6248
Country	:	US
Telephone Number	:	770-937-9003
Fax Number	:	770-937-9004

Provider Business Practice Location Address
First Line	:	2799 DELK RD SE STE 150
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-6248
Country	:	US
Telephone Number	:	770-937-9003
Fax Number	:	770-937-9004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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