Provider Demographics
NPI:1881912558
Name:NDUKA, LINDA G
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:G
Last Name:NDUKA
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 1:2316 BLACKWATCH CIR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-6097
Mailing Address - Country:US
Mailing Address - Phone:404-783-2144
Mailing Address - Fax:678-401-8945
Practice Address - Street 1:6200 GLEN OAKS LN NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4197
Practice Address - Country:US
Practice Address - Phone:404-783-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN041916164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse