MEDICARE: NNEAMAKA IFEADIKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP013059	GA

General Provider Information

NPI Number	:	1629947247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NNEAMAKA IFEADIKE

Provider Business Mailing Address
First Line	:	11130 MEDLOCK BRIDGE RD APT 1110
Second Line	:
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-8502
Country	:	US
Telephone Number	:	404-567-6214
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 PILGRIM VILLAGE DR STE 200
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30040-2583
Country	:	US
Telephone Number	:	678-395-3269
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/07/2025

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Directions to “ NNEAMAKA IFEADIKE ” Practice Location

Language	Start Address	Practice Location

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