Provider Demographics
NPI:1053003657
Name:OJAGBEGHRU, OGHENETEGA MARY (FNP)
Entity type:Individual
Prefix:
First Name:OGHENETEGA
Middle Name:MARY
Last Name:OJAGBEGHRU
Suffix:
Gender:F
Credentials:FNP
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Other - Credentials:
Mailing Address - Street 1:3235 AMBERGROVE TRCE
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-6811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4360 CHAMBLEE DUNWOODY RD STE 370
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1081
Practice Address - Country:US
Practice Address - Phone:770-232-6128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN280213363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology