Healthcare Provider Details

I. General information

NPI: 1457433948
Provider Name (Legal Business Name): AKPOBOME PATRICIA WODI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AKPOBOME PATRICIA SANOMI

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WHITCHER ST NE SUITE 160
MARIETTA GA
30060-1155
US

IV. Provider business mailing address

55 WHITCHER ST NE SUITE 160
MARIETTA GA
30060-1155
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-1372
  • Fax: 770-423-9651
Mailing address:
  • Phone: 770-422-1372
  • Fax: 770-423-9651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number63980
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: