Provider Demographics
NPI:1013169663
Name:USIANENEH, KINGSLEY EROMOSELE
Entity Type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:EROMOSELE
Last Name:USIANENEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 COBBLESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-6843
Mailing Address - Country:US
Mailing Address - Phone:678-516-8594
Mailing Address - Fax:
Practice Address - Street 1:2308 COBBLESTONE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-6843
Practice Address - Country:US
Practice Address - Phone:678-516-8594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist