Healthcare Provider Details

I. General information

NPI: 1194682344
Provider Name (Legal Business Name): ENO BASSEY IKPEME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ENO BASSEY IKPEME

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 ANDERSON MILL RD APT 2307
AUSTELL GA
30106-1262
US

IV. Provider business mailing address

1650 ANDERSON MILL RD APT 2307
AUSTELL GA
30106-1262
US

V. Phone/Fax

Practice location:
  • Phone: 317-292-6996
  • Fax: 678-486-6828
Mailing address:
  • Phone: 317-292-6996
  • Fax: 678-486-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: