Healthcare Provider Details

I. General information

NPI: 1306152871
Provider Name (Legal Business Name): ESTHER IJEOMA IWOTOR NP - C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ESTHER IJEOMA NKENKE RNP

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 VININGS RETREAT VW SW
MABLETON GA
30126-2574
US

IV. Provider business mailing address

257 VININGS RETREAT VW SW
MABLETON GA
30126-2574
US

V. Phone/Fax

Practice location:
  • Phone: 404-387-1320
  • Fax:
Mailing address:
  • Phone: 770-948-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN109484
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: