Provider Demographics
NPI:1730475799
Name:CHIMAOBI, AGNES ONYINYE
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:ONYINYE
Last Name:CHIMAOBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:
Other - Last Name:CHIMAOBI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN BSN
Mailing Address - Street 1:2326 MAGAW LN
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-5629
Mailing Address - Country:US
Mailing Address - Phone:678-361-8919
Mailing Address - Fax:
Practice Address - Street 1:2326 MAGAW LN
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-5629
Practice Address - Country:US
Practice Address - Phone:678-361-8919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN184666323P00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health