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General NPI Number Information
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NPI Number | 1982357778
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Entity Type | Individual
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Provider Name | ANGE TETSADJIO PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 03/29/2022
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Provider Practice Location Address
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Address Line | 3200 HOLCOMB BRIDGE RD
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-3361
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Country | US
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Telephone | 404-671-5297
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Fax |
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Provider Business Mailing Address
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Address Line | 4895 POST OAK TRITT RD NE
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City | ROSWELL
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State | GA
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Zip | 30075-4058
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Country | US
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Telephone | 404-375-1526
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 033137
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License Number State | GA
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