Provider Demographics
NPI:1982868915
Name:NDEM, IMO FRIDAY (MD)
Entity type:Individual
Prefix:DR
First Name:IMO
Middle Name:FRIDAY
Last Name:NDEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4111 OLD PETERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3346
Mailing Address - Country:US
Mailing Address - Phone:706-228-2929
Mailing Address - Fax:706-228-9996
Practice Address - Street 1:4111 OLD PETERSBURG RD
Practice Address - Street 2:PATHWAY TO WELLNESS CENTER,PC
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3346
Practice Address - Country:US
Practice Address - Phone:706-228-2929
Practice Address - Fax:706-228-9996
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0609682083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine