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NPI Code Detail

MEDICARE: ENOMA EVBUOMWAN

MEDICARE: ENOMA EVBUOMWAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant007457GA

General Provider Information

NPI Number : 1578954640
Entity Type Code : Individual
Provider Name (Legal Business Name) : ENOMA EVBUOMWAN
Provider Business Mailing Address
First Line : 4519 WOODRUFF RD STE 4
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-6096
Country : US
Telephone Number : 706-653-2255
Fax Number : 706-653-2329
Provider Business Practice Location Address
First Line : 2737 WARM SPRINGS RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-6859
Country : US
Telephone Number : 706-653-2255
Fax Number : 706-653-2329
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2015
Last Update Date : 03/02/2026

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Directions to “ ENOMA EVBUOMWAN ” Practice Location

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