Healthcare Provider Details

I. General information

NPI: 1306390349
Provider Name (Legal Business Name): EMMANUEL EYEFIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 PIEDMONT RD NE 2101
ATLANTA GA
30324-6262
US

IV. Provider business mailing address

1300 NEWTON RD
ALBANY GA
31701-3424
US

V. Phone/Fax

Practice location:
  • Phone: 404-237-1755
  • Fax:
Mailing address:
  • Phone: 229-431-3120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN246171
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: