Provider Demographics
NPI:1871119164
Name:GATES, ONORIODE CHARLOTTE
Entity type:Individual
Prefix:
First Name:ONORIODE
Middle Name:CHARLOTTE
Last Name:GATES
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 1:1495 UNION STATION CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3764
Mailing Address - Country:US
Mailing Address - Phone:678-755-8555
Mailing Address - Fax:
Practice Address - Street 1:1495 UNION STATION CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3764
Practice Address - Country:US
Practice Address - Phone:678-755-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHCP010797251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care