Provider Demographics
NPI:1982831616
Name:ODIOEMENE, NNAEMEZIE EMMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:NNAEMEZIE
Middle Name:EMMANUEL
Last Name:ODIOEMENE
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 1:1660 MULKEY RD
Mailing Address - Street 2:STE B
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1105
Mailing Address - Country:US
Mailing Address - Phone:267-266-4959
Mailing Address - Fax:
Practice Address - Street 1:1660 MULKEY RD
Practice Address - Street 2:STE B
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1105
Practice Address - Country:US
Practice Address - Phone:267-266-4959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-21
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68461207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology