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General NPI Number Information
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NPI Number | 1750027728
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Entity Type | Individual
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Provider Name | EVI ADDOH
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Gender | Female
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 1609 NORMAN DR STE B
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City | VALDOSTA
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State | GA
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Zip | 31601-3753
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Country | US
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Telephone | 229-269-4607
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Fax |
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Provider Business Mailing Address
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Address Line | 4750 MAC RD APT B8
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City | VALDOSTA
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State | GA
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Zip | 31605-6392
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Country | US
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Telephone | 662-543-0519
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN122776
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License Number State | GA
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