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NPI Code Detail

MEDICARE: AKPOMUDIARE SAMUEL OTUGUOR MD

MEDICARE: AKPOMUDIARE SAMUEL OTUGUOR MD
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
1207P00000XEmergency Medicine PhysicianMD.38189AL
2207Q00000XFamily Medicine Physician4301086102MI
3207Q00000XFamily Medicine Physician65599GA
4208M00000XHospitalist Physician38189AL
5207Q00000XFamily Medicine Physician38788IA

General Provider Information

NPI Number : 1154534303
Entity Type Code : Individual
Provider Name (Legal Business Name) : AKPOMUDIARE SAMUEL OTUGUOR MD
Provider Business Mailing Address
First Line : 535 N CENTRAL AVE
Second Line :
City : HAPEVILLE
State : GA
Zip : 30354-1603
Country : US
Telephone Number : 404-761-4040
Fax Number : 404-761-4008
Provider Business Practice Location Address
First Line : 535 N CENTRAL AVE
Second Line :
City : HAPEVILLE
State : GA
Zip : 30354-1603
Country : US
Telephone Number : 404-761-4040
Fax Number : 404-761-4008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2007
Last Update Date : 02/20/2020

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