Provider Demographics
NPI:1417791690
Name:SODJE, ANDRE
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:SODJE
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 1:1298 RIVERWIND DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6414
Mailing Address - Country:US
Mailing Address - Phone:615-484-6695
Mailing Address - Fax:
Practice Address - Street 1:1919 JOHN WESLEY AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-3605
Practice Address - Country:US
Practice Address - Phone:404-762-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN319131163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse