Provider Demographics
NPI:1215608906
Name:DJOMOAH, GEOFFREY FRANCIS
Entity type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:FRANCIS
Last Name:DJOMOAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 CANARY FALLS LN APT 303
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-5851
Mailing Address - Country:US
Mailing Address - Phone:860-899-0960
Mailing Address - Fax:
Practice Address - Street 1:1350 SE MAYNARD RD STE 104
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-3634
Practice Address - Country:US
Practice Address - Phone:860-899-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16317225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist