Provider Demographics
NPI:1558098582
Name:OWONA, CHRISTEL
Entity Type:Individual
Prefix:
First Name:CHRISTEL
Middle Name:
Last Name:OWONA
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 1:10247 HIGHWAY 92 # 300-204
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3914
Mailing Address - Country:US
Mailing Address - Phone:770-256-6117
Mailing Address - Fax:
Practice Address - Street 1:225 CREEKSTONE RDG STE 20
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3744
Practice Address - Country:US
Practice Address - Phone:770-256-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT012745225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist