Provider Demographics
NPI:1396412870
Name:OBIORAH, CHARISE
Entity Type:Individual
Prefix:
First Name:CHARISE
Middle Name:
Last Name:OBIORAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 FOUNTAIN DR STE 301J
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6783
Mailing Address - Country:US
Mailing Address - Phone:678-395-3225
Mailing Address - Fax:678-691-1043
Practice Address - Street 1:2151 FOUNTAIN DR STE 301J
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6783
Practice Address - Country:US
Practice Address - Phone:678-395-3225
Practice Address - Fax:678-691-1043
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHCP010670376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide