Provider Demographics
NPI:1013034453
Name:ADU, AGNES (OD)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:ADU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 WESTWATER RDG
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5697
Mailing Address - Country:US
Mailing Address - Phone:770-598-7512
Mailing Address - Fax:
Practice Address - Street 1:373 WESTWATER RDG
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-5697
Practice Address - Country:US
Practice Address - Phone:770-598-7512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001522152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist