Provider Demographics
NPI:1710242276
Name:NNODIM, AHAMEFULA (MD)
Entity Type:Individual
Prefix:DR
First Name:AHAMEFULA
Middle Name:
Last Name:NNODIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-1401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:235 PEACHTREE ST NE
Practice Address - Street 2:SUITE 2100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1401
Practice Address - Country:US
Practice Address - Phone:770-994-9326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101365390200000X
GA076122207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program