Healthcare Provider Details

I. General information

NPI: 1205465366
Provider Name (Legal Business Name): ADAUGO AMAH SANYI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ADAUGO IFEOMA AMAH MD

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 MAPLE DR NE
ATLANTA GA
30305-2515
US

IV. Provider business mailing address

3131 MAPLE DR NE STE 102
ATLANTA GA
30305-2515
US

V. Phone/Fax

Practice location:
  • Phone: 404-816-7900
  • Fax:
Mailing address:
  • Phone: 404-704-4066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number111966
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: