Most Relevant Information
Provider Data
| NPI Number: | 1003490764 |
| Provider Name: | GLORY OSADIAYE PMHNP, MSN, BSN, RN |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | RN250999 |
Most Important Dates
| Enumeration Date: | 05/10/2021 |
| Last Updated: | 06/11/2023 |
Provider Practice Location
250 CONSTITUTION BLVD
LAWRENCEVILLE
GA
300468432
Practice Location Phone/Fax
| Phone: | 4708440157 |
| Fax: | 6785398899 |
Provider Mailing Location
250 CONSTITUTION BLVD
LAWRENCEVILLE
GA
300468432
Provider Mailing Phone/Fax
| Phone: | 4708440157 |
| Fax: |