MEDICARE: DR. GLORY DIOH-ESONA DNP, NP-C, APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN240522	GA
2	363LF0000X	Family Nurse Practitioner	RN240522	GA

General Provider Information

NPI Number	:	1356822126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLORY DIOH-ESONA DNP, NP-C, APRN

Provider Business Mailing Address
First Line	:	2340 DEESIDE SE
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6470
Country	:	US
Telephone Number	:	404-494-6774
Fax Number	:

Provider Business Practice Location Address
First Line	:	3375 MEMORIAL DR STE G
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-2706
Country	:	US
Telephone Number	:	404-494-6774
Fax Number	:

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

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	12/15/2025

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