Provider Demographics
NPI:1477264448
Name:ADADE, KOGBA
Entity type:Individual
Prefix:
First Name:KOGBA
Middle Name:
Last Name:ADADE
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 1:2432 SWEET BIRCH CT
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1310
Mailing Address - Country:US
Mailing Address - Phone:704-963-5242
Mailing Address - Fax:
Practice Address - Street 1:2432 SWEET BIRCH CT GASTONIA
Practice Address - Street 2:
Practice Address - City:GASTONIA, NC
Practice Address - State:NC
Practice Address - Zip Code:28054-1310
Practice Address - Country:US
Practice Address - Phone:704-963-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver