Individual
MODUPE BANJOH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30046-8444
(678) 209-2394
Mailing address
3165 MANOR CT, SNELLVILLE, GA 30078-2953
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
RN285748
GA
Other
Enumeration date
05/25/2020
Last updated
05/25/2020
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