Individual
DR. THEODORA MBANEFO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3650 STEVE REYNOLDS BLVD, DEPARTMENT OF INTERNAL MEDICINE, DULUTH, GA 30096-4506
(770) 931-6065
Mailing address
3495 PIEDMONT RD NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305-1773
(404) 364-7000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
056596
GA
Other
Enumeration date
12/01/2006
Last updated
07/08/2007
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