Provider Demographics
NPI:1790679777
Name:UDOKORO, NNEDI (NP)
Entity type:Individual
Prefix:
First Name:NNEDI
Middle Name:
Last Name:UDOKORO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2068 SKYBROOKE CT
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-6279
Mailing Address - Country:US
Mailing Address - Phone:470-646-6034
Mailing Address - Fax:
Practice Address - Street 1:8735 DUNWOODY PL STE R
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-2995
Practice Address - Country:US
Practice Address - Phone:470-646-6034
Practice Address - Fax:678-737-1449
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily