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General NPI Number Information
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NPI Number | 1851539191
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Entity Type | Individual
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Provider Name | SOLOMON B. UDO CEO
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Gender | Male
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Dates
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Enumeration Date | 01/23/2009
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 3102 PERCH OVERLOOK SW
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City | MARIETTA
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State | GA
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Zip | 30008-5977
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Country | US
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Telephone | 404-274-7465
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Fax | 770-726-7245
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Provider Business Mailing Address
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Address Line | 3102 PERCH OVERLOOK SW
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City | MARIETTA
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State | GA
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Zip | 30008-5977
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Country | US
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Telephone | 404-274-7465
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Fax | 770-726-7245
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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 | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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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 | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State | GA
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