Provider Demographics
NPI:1235929969
Name:OGBURU, AMARTHA EZINNE (NP)
Entity type:Individual
Prefix:
First Name:AMARTHA
Middle Name:EZINNE
Last Name:OGBURU
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 PAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1636
Mailing Address - Country:US
Mailing Address - Phone:404-921-4366
Mailing Address - Fax:
Practice Address - Street 1:502 PAYNE RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-1636
Practice Address - Country:US
Practice Address - Phone:404-921-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN253492363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily