Healthcare Provider Details

I. General information

NPI: 1457015075
Provider Name (Legal Business Name): EUDIAH OCHIENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 10/29/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 UPPER HEMBREE RD STE B
ROSWELL GA
30076-0927
US

IV. Provider business mailing address

3207 HENDERSON MILL RD APT O5
ATLANTA GA
30341-6011
US

V. Phone/Fax

Practice location:
  • Phone: 678-736-7680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number10149
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: