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NPI Code Detail

MEDICARE: DR. ERNESTINE NONYE JIDEAMA MD

MEDICARE: DR. ERNESTINE NONYE JIDEAMA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician550256TX
2208000000XPediatrics PhysicianME131259FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023312832
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERNESTINE NONYE JIDEAMA MD
Provider Business Mailing Address
First Line : 236 ARROWHEAD BLVD
Second Line :
City : JONESBORO
State : GA
Zip : 30236-1106
Country : US
Telephone Number : 770-478-9240
Fax Number :
Provider Business Practice Location Address
First Line : 285 SE 5TH AVE
Second Line :
City : DELRAY BEACH
State : FL
Zip : 33483-5206
Country : US
Telephone Number : 561-272-8991
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2011
Last Update Date : 03/17/2021

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