Healthcare Provider Details

I. General information

NPI: 1225776982
Provider Name (Legal Business Name): JENNIFER EBIRERI AKPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 SOUTHERN DR
STATESBORO GA
30460-1360
US

IV. Provider business mailing address

28926 YULEE MILL DR
KATY TX
77494-5590
US

V. Phone/Fax

Practice location:
  • Phone: 912-478-4636
  • Fax:
Mailing address:
  • Phone: 916-692-4889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: