MEDICARE: AMORITA ENYIOMA

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
1	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1225994932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMORITA ENYIOMA

Provider Business Mailing Address
First Line	:	683 FAIRFAX PL # 26BA
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-5322
Country	:	US
Telephone Number	:	678-994-3353
Fax Number	:

Provider Business Practice Location Address
First Line	:	11755 W THOMPSON RANCH RD APT 95
Second Line	:
City	:	EL MIRAGE
State	:	AZ
Zip	:	85335-3276
Country	:	US
Telephone Number	:	678-994-3353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2025
Last Update Date	:	12/27/2025

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Directions to “ AMORITA ENYIOMA ” Practice Location

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