Provider Demographics
NPI:1629851035
Name:AZIZ, YENMOAKEBE
Entity Type:Individual
Prefix:
First Name:YENMOAKEBE
Middle Name:
Last Name:AZIZ
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 1:2044 WEEMS RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5207
Mailing Address - Country:US
Mailing Address - Phone:470-870-6554
Mailing Address - Fax:
Practice Address - Street 1:2044 WEEMS RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5207
Practice Address - Country:US
Practice Address - Phone:470-870-6554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABACB925894106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician