Provider Demographics
NPI:1760113187
Name:NWAEDOZIE, IFEOMA O (DPM)
Entity type:Individual
Prefix:
First Name:IFEOMA
Middle Name:O
Last Name:NWAEDOZIE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JOHN MADDOX DR NW STE A
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1481
Mailing Address - Country:US
Mailing Address - Phone:706-232-6739
Mailing Address - Fax:706-232-6750
Practice Address - Street 1:101 JOHN MADDOX DR NW STE A
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1481
Practice Address - Country:US
Practice Address - Phone:706-232-6739
Practice Address - Fax:706-232-6750
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD305049213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty