Provider Demographics
NPI:1568239424
Name:NWADIKE, GRACE CHIDINMA
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:CHIDINMA
Last Name:NWADIKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 COLUMBUS CIR
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-6698
Mailing Address - Country:US
Mailing Address - Phone:404-454-8111
Mailing Address - Fax:
Practice Address - Street 1:4501 COLUMBUS CIR
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-6698
Practice Address - Country:US
Practice Address - Phone:404-454-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN243036363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health