Healthcare Provider Details

I. General information

NPI: 1407091267
Provider Name (Legal Business Name): JOY EKPO UYA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOY IFIOK EKPO D.O.

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SATELLITE BLVD NW BLDG 1100 STE. 1110
SUWANEE GA
30024
US

IV. Provider business mailing address

10945 STATE BRIDGE RD STE 401-191
ALPHARETTA GA
30022-8164
US

V. Phone/Fax

Practice location:
  • Phone: 470-264-0101
  • Fax: 470-589-1126
Mailing address:
  • Phone: 972-813-9372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4755
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP4307
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number78329
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: