Provider Demographics
NPI:1356970354
Name:UDONGWO, NDAUSUNG EFFIONG (MD)
Entity type:Individual
Prefix:
First Name:NDAUSUNG
Middle Name:EFFIONG
Last Name:UDONGWO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:483 UPPER RIVERDALE RD SW STE F
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2579
Mailing Address - Country:US
Mailing Address - Phone:770-742-3883
Mailing Address - Fax:855-597-8504
Practice Address - Street 1:705 JUNIPER ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1307
Practice Address - Country:US
Practice Address - Phone:770-742-3883
Practice Address - Fax:855-597-8504
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA96914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine