Individual
NKIRUKA J UDEJIOFOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
750 TOWN PARK LANE, KAISER PERMANENLE TOWN PARK COMPREHENSIVE MEDICAL CENTE, KENNESAW, GA 30144
(770) 514-5401
Mailing address
3495 PIEDMONT ROAD, NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305
(404) 504-5678
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01061199A
IN
207Q00000X
Family Medicine Physician
Primary
059340
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003104939A
—
GA
05
—
003104939B
—
GA
05
—
GA1145
—
SC
01
—
P00924822
RR MEDICARE
GA
Enumeration date
10/04/2006
Last updated
09/23/2024
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