Healthcare Provider Details

I. General information

NPI: 1922453695
Provider Name (Legal Business Name): ANNE AURELIE NGO TEDGA MOCHE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 EAGLES WALK STE 150
STOCKBRIDGE GA
30281-7207
US

IV. Provider business mailing address

2831 LAKE JODECO RD
JONESBORO GA
30236-5335
US

V. Phone/Fax

Practice location:
  • Phone: 470-507-0029
  • Fax: 470-507-0030
Mailing address:
  • Phone: 240-329-8974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number97043
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number97043
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: