Amanueal Wodajo

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

PHRE008944 Issued in GA

Practice address

457 Nathan Dean Blvd
Dallas, GA 30132-4911

Phone

(770) 443-8776

Fax

(770) 443-0653

NPI assigned

Jan 31, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Kroger Co

  • Community/Retail Pharmacy
  • Dallas, GA
  • NPI 1093730871
  NPD
• Kroger Co

  • Community/Retail Pharmacy
  • Bethlehem, GA
  • NPI 1154294205
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1580428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580428800000",
    "number": "1952932600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "457 NATHAN DEAN BLVD",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301324911",
            "telephone_number": "770-443-8776",
            "fax_number": "770-443-0653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "457 NATHAN DEAN BLVD",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301324911",
            "telephone_number": "770-443-8776",
            "fax_number": "770-443-0653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WODAJO",
        "first_name": "AMANUEAL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-31",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "GA",
            "license": "PHRE008944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Suzanne Williamson-Kersey, LMSW, CSW, CADC LL,
• Dorella Wilson-Woods
• Jordan Wilson
• Martin Ralph Wilson, D.C.
• Chandler Winner, PT
• Bridgette Denise Wokal, SA-C
• Saba Woldegebriel, RPH
• Mark Stephen Wolfe, PH.D.
• Chris Womack
• Kara Lindsey Womack

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Dallas, GA
• Providers in Dallas, GA by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.