Individual
IJE EGO OFODILE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3720 DAVINCI CT STE 400, NORCROSS, GA 30092-7625
(770) 300-3502
Mailing address
1799 COOPER LAKES DR, GRAYSON, GA 30017-2999
(678) 478-1093
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN107027 NP
GA
Other
Enumeration date
03/20/2006
Last updated
05/13/2014
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