Provider Demographics
NPI:1386697035
Name:NDEM, NDEM UDOUDO (DPM)
Entity type:Individual
Prefix:DR
First Name:NDEM
Middle Name:UDOUDO
Last Name:NDEM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:NDEM
Other - Middle Name:UDOUDO
Other - Last Name:NDEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1911 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8030
Mailing Address - Country:US
Mailing Address - Phone:706-653-5544
Mailing Address - Fax:706-653-5545
Practice Address - Street 1:1911 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8030
Practice Address - Country:US
Practice Address - Phone:706-653-5544
Practice Address - Fax:706-653-5545
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000872213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000832345AMedicaid
GA202G700257Medicare PIN
U68870Medicare UPIN
GA48SCCBNMedicare ID - Type Unspecified
GA202I480269Medicare PIN