Healthcare Provider Details

I. General information

NPI: 1366898330
Provider Name (Legal Business Name): JOSEPHINE U ANUFORO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MERCHANTS SQ
DALLAS GA
30132-5029
US

IV. Provider business mailing address

280 MERCHANTS SQ
DALLAS GA
30132-5029
US

V. Phone/Fax

Practice location:
  • Phone: 678-398-9758
  • Fax: 404-692-5438
Mailing address:
  • Phone: 678-398-9758
  • Fax: 404-692-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number84054
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: