Active NPI
Eunice Roseline Koboo
- Gerontology Nurse Practitioner
- Lithonia, GA
National Provider Identifier
1518669696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- RN203401
- Practice address
- 7493 Redbud Loop
Lithonia, GA 30038-3364 - Phone
- (404) 604-4597
- NPI assigned
- Mar 21, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | RN203401 | GA | Primary |
Addresses
Primary practice location
7493 Redbud Loop
Lithonia, GA 30038-3364
Mailing address
7493 Redbud Loop
Lithonia, GA 30038-3364
Phone (404) 604-4597
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN203401 | GA | MD | Gerontology Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679356800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679356800000",
"number": "1518669696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7493 REDBUD LOOP",
"city": "LITHONIA",
"state": "GA",
"postal_code": "300383364",
"telephone_number": "404-604-4597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7493 REDBUD LOOP",
"city": "LITHONIA",
"state": "GA",
"postal_code": "300383364",
"telephone_number": "404-604-4597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOBOO",
"first_name": "EUNICE",
"middle_name": "ROSELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-21",
"last_updated": "2023-03-21",
"certification_date": "2023-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "GA",
"license": "RN203401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lithonia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.