MEDICARE: IDIATOU SOW NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	APRN-NP255711	GA

General Provider Information

NPI Number	:	1053270777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDIATOU SOW NP

Provider Business Mailing Address
First Line	:	7822 LAUREL CREST DR
Second Line	:
City	:	JOHNS CREEK
State	:	GA
Zip	:	30024-4753
Country	:	US
Telephone Number	:	404-914-6933
Fax Number	:

Provider Business Practice Location Address
First Line	:	2685 PEACHTREE PKWY
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-5646
Country	:	US
Telephone Number	:	770-771-5260
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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