Healthcare Provider Details

I. General information

NPI: 1205225141
Provider Name (Legal Business Name): JANET IGWEBUIKE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

1119 TUMLIN CT
LAWRENCEVILLE GA
30045-2702
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-2509
  • Fax: 404-616-0787
Mailing address:
  • Phone: 404-401-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN204191
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: