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General NPI Number Information
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NPI Number | 1841653508
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Entity Type | Individual
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Provider Name | EMEKA IHENATU M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 04/08/2021
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Provider Practice Location Address
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Address Line | 1200 MEMORIAL DR
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City | DALTON
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State | GA
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Zip | 30720-2529
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Country | US
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Telephone | 919-525-7903
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Fax |
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Provider Business Mailing Address
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Address Line | 214 WILD ROSE CIR
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City | CANTON
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State | GA
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Zip | 30115-9371
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Country | US
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Telephone | 919-525-7903
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 83843
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License Number State | GA
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