Provider Demographics
NPI:1851539191
Name:UDO, SOLOMON B (CEO)
Entity Type:Individual
Prefix:
First Name:SOLOMON
Middle Name:B
Last Name:UDO
Suffix:
Gender:M
Credentials:CEO
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Mailing Address - Street 1:3102 PERCH OVERLOOK SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-5977
Mailing Address - Country:US
Mailing Address - Phone:404-274-7465
Mailing Address - Fax:770-726-7245
Practice Address - Street 1:3102 PERCH OVERLOOK SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-5977
Practice Address - Country:US
Practice Address - Phone:404-274-7465
Practice Address - Fax:770-726-7245
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
332BP3500X
GA332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition