Provider Demographics
NPI:1346133808
Name:ONI, SAMURAT I (PMHNP)
Entity type:Individual
Prefix:
First Name:SAMURAT
Middle Name:I
Last Name:ONI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LANIER AVE W STE 908E
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7641
Mailing Address - Country:US
Mailing Address - Phone:321-594-3390
Mailing Address - Fax:
Practice Address - Street 1:500 LANIER AVE W STE 908E
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7641
Practice Address - Country:US
Practice Address - Phone:321-594-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05250096163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health