Provider Demographics
NPI:1184267700
Name:KOUDADJE, ADOUN
Entity type:Individual
Prefix:
First Name:ADOUN
Middle Name:
Last Name:KOUDADJE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-7570
Mailing Address - Country:US
Mailing Address - Phone:678-313-3424
Mailing Address - Fax:
Practice Address - Street 1:2511 ARBOR DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-7570
Practice Address - Country:US
Practice Address - Phone:678-313-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-26
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-R-1939374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide