Provider Demographics
NPI:1447530605
Name:ANYANWU, JUSTINA NGOZI (NP-C)
Entity type:Individual
Prefix:MRS
First Name:JUSTINA
Middle Name:NGOZI
Last Name:ANYANWU
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 HARDEE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-4711
Mailing Address - Country:US
Mailing Address - Phone:770-505-0531
Mailing Address - Fax:770-485-0570
Practice Address - Street 1:539 HARDEE ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-4711
Practice Address - Country:US
Practice Address - Phone:770-505-0531
Practice Address - Fax:770-485-0570
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN156181363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health