Healthcare Provider Details

I. General information

NPI: 1093259418
Provider Name (Legal Business Name): FRANCA OGBEMUDIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 PLANTATION GLEN CT
ALPHARETTA GA
30022-4957
US

IV. Provider business mailing address

235 PLANTATION GLEN CT
ALPHARETTA GA
30022-4957
US

V. Phone/Fax

Practice location:
  • Phone: 404-484-8224
  • Fax:
Mailing address:
  • Phone: 404-484-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number060-R-1558
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: