Ifeoma Veronica Nnoli

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

PT017144 Issued in GA

Practice address

500 Springhouse Cir
Stone Mountain, GA 30087-6741

Phone

(678) 684-3300

NPI assigned

Jul 1, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1609611573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3746 WOOD HOLLOW WAY",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300396039",
            "telephone_number": "770-868-9378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SPRINGHOUSE CIR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300876741",
            "telephone_number": "678-684-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NNOLI",
        "first_name": "IFEOMA",
        "middle_name": "VERONICA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-01",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "GA",
            "license": "PT017144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Physical Therapy Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.