Provider Demographics
NPI:1225385248
Name:OBADAN, NDIDIAMAKA O (MD,MS)
Entity Type:Individual
Prefix:DR
First Name:NDIDIAMAKA
Middle Name:O
Last Name:OBADAN
Suffix:
Gender:F
Credentials:MD,MS
Other - Prefix:DR
Other - First Name:NDIDIAMAKA
Other - Middle Name:O
Other - Last Name:EGBOCHUKU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:3105 CREEKSIDE VILLAGE DR NW STE 801
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4218
Mailing Address - Country:US
Mailing Address - Phone:404-566-4623
Mailing Address - Fax:
Practice Address - Street 1:3105 CREEKSIDE VILLAGE DR NW STE 801
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4218
Practice Address - Country:US
Practice Address - Phone:404-566-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37945207R00000X, 207RN0300X
GA84055207RH0005X, 207RN0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program