Provider Demographics
NPI:1730884594
Name:MUOGOR, DORIS CHINYERE
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:CHINYERE
Last Name:MUOGOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 PEACHTREE INDUSTRIAL BLVD APT 1125
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5577
Mailing Address - Country:US
Mailing Address - Phone:404-563-1723
Mailing Address - Fax:
Practice Address - Street 1:1630 PEACHTREE INDUSTRIAL BLVD APT 1125
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-5577
Practice Address - Country:US
Practice Address - Phone:404-563-1723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM71099163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse