Provider Demographics
NPI:1043870967
Name:NDICHU, CATHERINE KIENDE
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:KIENDE
Last Name:NDICHU
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 1:2835 CHAPMAN CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3673
Mailing Address - Country:US
Mailing Address - Phone:678-368-6838
Mailing Address - Fax:
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 320
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4357
Practice Address - Country:US
Practice Address - Phone:678-341-6370
Practice Address - Fax:770-509-0601
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA212957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty