Provider Demographics
NPI:1174332084
Name:TIOGOUONG MAFOUO, AURELE M (ATM)
Entity type:Individual
Prefix:
First Name:AURELE
Middle Name:M
Last Name:TIOGOUONG MAFOUO
Suffix:
Gender:M
Credentials:ATM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4869 KINGSHILL DR APT 209
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6263
Mailing Address - Country:US
Mailing Address - Phone:443-410-8102
Mailing Address - Fax:
Practice Address - Street 1:4869 KINGSHILL DR APT 209
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6263
Practice Address - Country:US
Practice Address - Phone:443-410-8102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH652326-DD00296558103K00000X, 208VP0000X, 251J00000X, 3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No251J00000XAgenciesNursing Care