Provider Demographics
NPI:1417338013
Name:ADZUDZOR, PETER K (MA)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:K
Last Name:ADZUDZOR
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 GARDEN MIST CIR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-2375
Mailing Address - Country:US
Mailing Address - Phone:678-201-8859
Mailing Address - Fax:
Practice Address - Street 1:127 CHURCH ST NE
Practice Address - Street 2:SUITE 350
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8637
Practice Address - Country:US
Practice Address - Phone:404-828-0087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional