Healthcare Provider Details

I. General information

NPI: 1124951918
Provider Name (Legal Business Name): INEMESIT UDO OTUMMKPO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1962 SPECTRUM CIR SE APT 630
MARIETTA GA
30067-6099
US

IV. Provider business mailing address

1962 SPECTRUM CIR SE APT 630
MARIETTA GA
30067-6099
US

V. Phone/Fax

Practice location:
  • Phone: 404-798-5396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberNP275642
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberNP275642
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: