Individual
INIMFON E UBOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
535 GROVE PARK PL, ROSWELL, GA 30075-6873
(470) 383-9999
Mailing address
535 GROVE PARK PL, ROSWELL, GA 30075-6873
(470) 383-9999
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
006204
NC
367500000X
Certified Registered Nurse Anesthetist
29624
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
RN202032
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/03/2019
Last updated
10/27/2021
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