Healthcare Provider Details

I. General information

NPI: 1720659980
Provider Name (Legal Business Name): LINDA ENJEMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4938 ZOYA CT SW
ATLANTA GA
30331-7527
US

IV. Provider business mailing address

4938 ZOYA CT SW
ATLANTA GA
30331-7527
US

V. Phone/Fax

Practice location:
  • Phone: 404-729-5437
  • Fax: 404-745-8399
Mailing address:
  • Phone: 404-729-5437
  • Fax: 404-745-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberRN274835
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN274835
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: