Provider Demographics
NPI:1700385374
Name:ASIEDU, ENOCH K (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ENOCH
Middle Name:K
Last Name:ASIEDU
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1641 BRANDON GLEN WAY NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3888
Mailing Address - Country:US
Mailing Address - Phone:718-314-5598
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE STE D112
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-2401
Practice Address - Country:US
Practice Address - Phone:718-920-5013
Practice Address - Fax:718-920-2629
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2021-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA103952085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology