Provider Demographics
NPI:1457433948
Name:WODI, AKPOBOME PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:AKPOBOME
Middle Name:PATRICIA
Last Name:WODI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AKPOBOME
Other - Middle Name:PATRICIA
Other - Last Name:SANOMI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-422-1372
Mailing Address - Fax:770-423-9651
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 160
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-422-1372
Practice Address - Fax:770-423-9651
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63980208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
370000465Medicare ID - Type Unspecified
MS00722857Medicaid
I49706Medicare UPIN