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General NPI Number Information
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NPI Number | 1508147612
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Entity Type | Individual
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Provider Name | NIKETHA AJODHA
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Gender | Female
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 7050 HIGHWAY 85
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City | RIVERDALE
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State | GA
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Zip | 30274-2946
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Country | US
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Telephone | 770-994-1670
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Fax |
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Provider Business Mailing Address
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Address Line | 6640 NW 20TH ST
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City | MARGATE
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State | FL
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Zip | 33063-2102
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Country | US
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Telephone | 954-821-2827
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002664
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License Number State | GA
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