Individual
EDWIGE GOBY KONWO-TAYO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1183 S HAIRSTON RD STE A, STONE MOUNTAIN, GA 30088-2796
(404) 296-8858
Mailing address
814 LAZARUS DR, WOODSTOCK, GA 30188-5100
(404) 825-6874
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
RN220667
GA
363LF0000X
Family Nurse Practitioner
Primary
RN220667
GA
Other
Enumeration date
07/23/2018
Last updated
12/30/2019
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