Healthcare Provider Details

I. General information

NPI: 1235529611
Provider Name (Legal Business Name): FRANCES OFFIAH IDOWU NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 SOUTH COBB DRIVE
SMYRNA GA
30082
US

IV. Provider business mailing address

3240 S COBB DR SE
SMYRNA GA
30080-4194
US

V. Phone/Fax

Practice location:
  • Phone: 404-397-9689
  • Fax:
Mailing address:
  • Phone: 404-397-9689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number145774
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: