Provider Demographics
NPI:1356822126
Name:DIOH-ESONA, GLORY (DNP, NP-C, APRN)
Entity Type:Individual
Prefix:DR
First Name:GLORY
Middle Name:
Last Name:DIOH-ESONA
Suffix:
Gender:F
Credentials:DNP, NP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 DEESIDE SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6470
Mailing Address - Country:US
Mailing Address - Phone:404-494-6774
Mailing Address - Fax:
Practice Address - Street 1:2340 DEESIDE SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6470
Practice Address - Country:US
Practice Address - Phone:404-494-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN240522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty