Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 006294 | NY |
Y | 213EP1101X | Primary Podiatric Medicine | POD001142 | GA |
N | 213ES0103X | Foot & Ankle Surgery | POD001142 | GA |
NPI | 1275780199 |
---|---|
Provider Name | Dr. Azuka Ifeyinwa Nwaedozie |
First Address | Jonesboro, GA 30236-6873 |
Second Address | Jonesboro, GA 30236-6873 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2008 |
Last Update Date | 29/04/2014 |