Healthcare Provider Details

I. General information

NPI: 1457932345
Provider Name (Legal Business Name): IMIENRELUEFE ADODO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 JOE FRANK HARRIS PKWY SE
CARTERSVILLE GA
30120-2129
US

IV. Provider business mailing address

525 RAYMOND ST
MARIETTA GA
30008-9900
US

V. Phone/Fax

Practice location:
  • Phone: 470-490-1000
  • Fax:
Mailing address:
  • Phone: 770-990-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP95252
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number95252
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: