Provider Demographics
NPI:1164832101
Name:ASHONG, DESIREE OGBEDEI (MD)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:OGBEDEI
Last Name:ASHONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:OGBEDEI
Other - Last Name:ASHONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 UPPER HEMBREE RD STE D
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0927
Mailing Address - Country:US
Mailing Address - Phone:770-670-6170
Mailing Address - Fax:770-670-6171
Practice Address - Street 1:1300 UPPER HEMBREE RD STE D
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-0927
Practice Address - Country:US
Practice Address - Phone:770-670-6170
Practice Address - Fax:770-670-6171
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA081070207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003212196CMedicaid