Healthcare Provider Details

I. General information

NPI: 1508824103
Provider Name (Legal Business Name): IFEOMA NJOKU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 03/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 EISENHOWER PKWY
MACON GA
31206-0800
US

IV. Provider business mailing address

3780 EISENHOWER PARKWAY
MACON GA
31206
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-5550
  • Fax: 478-784-3550
Mailing address:
  • Phone: 478-633-0550
  • Fax: 478-633-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number009143
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: