Individual
KIBIBI WANZU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
366 RACETRACK RD, MCDONOUGH, GA 30252-1022
(470) 781-5585
(470) 781-5586
Mailing address
366 RACETRACK RD, MCDONOUGH, GA 30252-1022
(470) 781-5585
(470) 781-5586
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
POD001378
GA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD001378
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003207314
—
GA
05
—
003207314G
—
GA
01
—
14312441
CAQH
GA
Enumeration date
09/24/2015
Last updated
11/25/2024
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