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General NPI Number Information
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NPI Number | 1376717504
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Entity Type | Individual
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Provider Name | VICTORINE MAFOUEKA NGUENA M.D
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Gender | Female
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 12/01/2009
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Provider Practice Location Address
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Address Line | 3664 CLUB DR STE 201
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2959
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Country | US
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Telephone | 678-380-8433
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Fax | 678-380-8437
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Provider Business Mailing Address
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Address Line | 2012 LITTLE RIVER DR
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City | SUWANEE
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State | GA
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Zip | 30024-3266
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Country | US
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Telephone | 770-314-9245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 063092
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License Number State | GA
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