Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 081070 | GA |
NPI | 1164832101 |
---|---|
Provider Name | Desiree Ogbedei Ashong |
First Address | Roswell, GA 30076-0927 |
Second Address | Roswell, GA 30076-0927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2014 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003212196C | (05) | GA |