Individual
MS. ESOHE GRACE IDUSUYI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
4944 SEPTEMBER CT NW, ACWORTH, GA 30102-7915
(770) 975-9538
Mailing address
4944 SEPTEMBER COURT, ACWORTH, GA 30102
(770) 975-9538
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN144525NP
GA
Other
Enumeration date
10/17/2011
Last updated
10/17/2011
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