Individual
ITAUMA UDOSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2745 DEKALB MEDICAL PKWY STE 110, LITHONIA, GA 30058-4933
(770) 593-2382
(678) 514-2527
Mailing address
2745 DEKALB MEDICAL PKWY STE 110, LITHONIA, GA 30058-4933
(770) 593-2382
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
078910
GA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
78910
GA
Other
Enumeration date
06/01/2012
Last updated
07/21/2022
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