Provider Demographics
NPI:1881765030
Name:ONA, NORVIN ILAO (DO)
Entity type:Individual
Prefix:
First Name:NORVIN
Middle Name:ILAO
Last Name:ONA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1925 OLD PEACHTREE RD NE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2822
Mailing Address - Country:US
Mailing Address - Phone:770-339-5999
Mailing Address - Fax:770-277-9159
Practice Address - Street 1:1925 OLD PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-2822
Practice Address - Country:US
Practice Address - Phone:770-339-5999
Practice Address - Fax:770-277-9159
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA037634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA732308OtherBLUE CROSS
GAF75373Medicare UPIN
GA08LLCKJMedicare ID - Type Unspecified