Healthcare Provider Details

I. General information

NPI: 1366719197
Provider Name (Legal Business Name): MWINGI IDA LOMAMI CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 MANCHESTER EXPY
COLUMBUS GA
31904-6878
US

IV. Provider business mailing address

46 GASTON AVE
TIFTON GA
31794-2075
US

V. Phone/Fax

Practice location:
  • Phone: 229-402-4219
  • Fax:
Mailing address:
  • Phone: 229-402-4219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN166752
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberRN166752
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: