Provider Demographics
NPI:1699962738
Name:DREW, NDIDI O (AA)
Entity type:Individual
Prefix:
First Name:NDIDI
Middle Name:O
Last Name:DREW
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:AMALACHI
Other - Middle Name:
Other - Last Name:OKAFOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:PO BOX 551420
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1420
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:855-851-4405
Practice Address - Street 1:575 PROFESSION DRIVE
Practice Address - Street 2:STE. 165
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3333
Practice Address - Country:US
Practice Address - Phone:770-277-3056
Practice Address - Fax:855-204-5244
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1638367H00000X
GA005240367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant