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General NPI Number Information
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NPI Number | 1740845635
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Entity Type | Individual
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Provider Name | MARIAGORRATHY NKIRU EJIKE
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Gender | Female
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 6224 HEAVENWOOD WAY
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-5658
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Country | US
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Telephone | 404-934-6981
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Fax |
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Provider Business Mailing Address
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Address Line | 6224 HEAVENWOOD WAY
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-5658
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Country | US
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Telephone | 404-934-6981
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN221552
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License Number State | GA
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