Provider Demographics
NPI:1487238978
Name:UDOSEN, NAOMI BASSEY
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:BASSEY
Last Name:UDOSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 JODECO STATION CIR E
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5886
Mailing Address - Country:US
Mailing Address - Phone:404-955-5252
Mailing Address - Fax:
Practice Address - Street 1:353 JODECO STATION CIR E
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5886
Practice Address - Country:US
Practice Address - Phone:140-495-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician