Provider Demographics
NPI:1215539432
Name:KUFORIJI, CAROLINE INIOBONG
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:INIOBONG
Last Name:KUFORIJI
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CAROLINE
Other - Middle Name:INIOBONG
Other - Last Name:UDOKANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2151 PEACHFORD RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6534
Mailing Address - Country:US
Mailing Address - Phone:770-455-3200
Mailing Address - Fax:
Practice Address - Street 1:2151 PEACHFORD RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6534
Practice Address - Country:US
Practice Address - Phone:770-455-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN275659163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice