Provider Demographics
NPI:1275780199
Name:NWAEDOZIE, AZUKA IFEYINWA (DPM)
Entity Type:Individual
Prefix:DR
First Name:AZUKA
Middle Name:IFEYINWA
Last Name:NWAEDOZIE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3364 MEDINA DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-6873
Mailing Address - Country:US
Mailing Address - Phone:678-489-6589
Mailing Address - Fax:678-489-6522
Practice Address - Street 1:3364 MEDINA DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-6873
Practice Address - Country:US
Practice Address - Phone:678-489-6589
Practice Address - Fax:678-489-6522
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006294213EP1101X
GAPOD001142213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery