Provider Demographics
NPI:1821284597
Name:ENADEGHE, TAWANA (RN)
Entity Type:Individual
Prefix:MS
First Name:TAWANA
Middle Name:
Last Name:ENADEGHE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 REED ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-2874
Mailing Address - Country:US
Mailing Address - Phone:404-893-5695
Mailing Address - Fax:404-893-5695
Practice Address - Street 1:505 REED ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-2874
Practice Address - Country:US
Practice Address - Phone:404-893-5695
Practice Address - Fax:404-893-5695
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN123164163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse