Individual
MUDIWA IRENE FAYE HOGAN MBELE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2910 EVANS MILL RD STE B-334, LITHONIA, GA 30038-2481
(404) 207-5595
Mailing address
3132 SPICY CEDAR LN, LITHONIA, GA 30038-7161
(678) 508-1935
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000929277B
—
GA
Enumeration date
08/03/2022
Last updated
08/03/2022
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