Individual
RAPHAEL SOPUNIM UDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1670 CLAIRMONT RD, DECATUR, GA 30033-4004
(000) 000-0000
Mailing address
3720 LONG LAKE DR, DOUGLASVILLE, GA 30135-7654
(770) 896-4689
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
241170
GA
Other
Enumeration date
08/23/2024
Last updated
08/23/2024
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