Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 84046 | GA |
NPI | 1033472261 |
---|---|
Provider Name | Dr. Jennifer Ifeoma Obi |
First Address | Lawrenceville, GA 30043-4954 |
Second Address | Snellville, GA 30078-2060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2012 |
Last Update Date | 17/10/2019 |