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Individual

KODJO VIVIEN AZIAMADJI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
6238 TURNER LAKE RD SW, COVINGTON, GA 30014-3057
(470) 971-2118
Mailing address
1477 ROGERS CROSSING DR, LITHONIA, GA 30058-7007
(678) 993-7263

Taxonomy

Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
RN242817
GA
363L00000X
Nurse Practitioner
Primary
RN242817
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1134703705
GA
Enumeration date
05/10/2021
Last updated
12/16/2022
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