Provider Demographics
NPI:1275183006
Name:ANANABA, OZIOMA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:OZIOMA
Middle Name:
Last Name:ANANABA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:OZIOMA
Other - Middle Name:
Other - Last Name:UBANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:525 CAMANO WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8377
Mailing Address - Country:US
Mailing Address - Phone:770-905-2257
Mailing Address - Fax:
Practice Address - Street 1:525 CAMANO WAY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8377
Practice Address - Country:US
Practice Address - Phone:770-905-2257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA227331363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty