Provider Demographics
NPI:1376717504
Name:MAFOUEKA NGUENA, VICTORINE (MD)
Entity Type:Individual
Prefix:MRS
First Name:VICTORINE
Middle Name:
Last Name:MAFOUEKA NGUENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:VICTORINE
Other - Middle Name:
Other - Last Name:MAFOUEKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2012 LITTLE RIVER DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3266
Mailing Address - Country:US
Mailing Address - Phone:770-314-9245
Mailing Address - Fax:
Practice Address - Street 1:3664 CLUB DR STE 201
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-2959
Practice Address - Country:US
Practice Address - Phone:678-380-8433
Practice Address - Fax:678-380-8437
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine