Individual
MRS. JOSEPHINE I IYABOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1191 FLAMINGO DR, AUSTELL, GA 30168-6109
(770) 732-6366
(770) 732-6399
Mailing address
1191 FLAMINGO DR, AUSTELL, GA 30168-6109
(770) 778-2067
(770) 732-6399
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
GA
372600000X
Adult Companion
—
GA
3747A0650X
Attendant Care Provider
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
033012271
LICENSE NUMBER
—
01
—
263470342
TAX ID
GA
Enumeration date
10/08/2010
Last updated
10/08/2010
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