MEDICARE: ADOUN KOUDADJE

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	374U00000X	Home Health Aide	067-R-1939	GA

General Provider Information

NPI Number	:	1184267700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADOUN KOUDADJE

Provider Business Mailing Address
First Line	:	705 TREE CREEK PKWY
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-8459
Country	:	US
Telephone Number	:	678-313-3424
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 TREE CREEK PKWY
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-8459
Country	:	US
Telephone Number	:	678-313-3424
Fax Number	:

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

Provider Enumeration Date	:	10/26/2019
Last Update Date	:	01/20/2026

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Directions to “ ADOUN KOUDADJE ” Practice Location

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