Individual
JUSTIN OTIWU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3965 BRADFORD WALK TRL, BUFORD, GA 30519-7840
(770) 355-4114
Mailing address
3965 BRADFORD WALK TRL, BUFORD, GA 30519-7840
(770) 355-4114
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
067-R-0704
GA
Other
Enumeration date
03/19/2012
Last updated
03/19/2012
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