Individual
SAMUEL KISSIEDU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6102 JEFFERSON CIR S, CHAMBLEE, GA 30341-2661
(321) 274-5712
Mailing address
6102 JEFFERSON CIR S, CHAMBLEE, GA 30341-2661
(321) 274-5712
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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