Individual
BENJAMIN OTIWU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3965 BRADFORD WALK TRL, BUFORD, GA 30519-7840
(678) 488-1093
Mailing address
3965 BRADFORD WALK TRL, BUFORD, GA 30519-7840
(678) 488-1093
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN283773
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
148574
GA
Other
Enumeration date
07/26/2023
Last updated
05/10/2024
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