Provider Demographics
NPI:1326883851
Name:UME, CHISOROM
Entity type:Individual
Prefix:MRS
First Name:CHISOROM
Middle Name:
Last Name:UME
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 1:651 EXCHANGE PL NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3747
Mailing Address - Country:US
Mailing Address - Phone:470-994-3637
Mailing Address - Fax:
Practice Address - Street 1:651 EXCHANGE PL NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3747
Practice Address - Country:US
Practice Address - Phone:470-994-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician