MEDICARE: ERNEST U AMUKAMARA

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	363LF0000X	Family Nurse Practitioner	RN201832NP	GA
2	363LF0000X	Family Nurse Practitioner	26NJ00153300	NJ
3	363LF0000X	Family Nurse Practitioner	RN201832 NP	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1548431091	OTHER	NJ	982 BROAD STREET
2	1932370483	OTHER	NJ	101 LUDLOW STREET
3	1972778413	OTHER	NJ	1150 SPRINGFIELD AVENUE
4	1235300799	OTHER	NJ	37 N DAY
5	1194996645	OTHER	NJ	444 WILLIAM STREET
6	1740345693	OTHER	NJ	741 BROADWAY
7	222747589	OTHER	NJ	NCHC TAX ID

General Provider Information

NPI Number	:	1356529101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNEST U AMUKAMARA

Provider Business Mailing Address
First Line	:	5615 OLD NATIONAL HWY. SUITE D
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-3244
Country	:	US
Telephone Number	:	770-997-2900
Fax Number	:	678-949-9310

Provider Business Practice Location Address
First Line	:	5615 OLD NATIONAL HWY STE D
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-3817
Country	:	US
Telephone Number	:	770-997-2900
Fax Number	:	678-949-9310

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

Provider Enumeration Date	:	02/04/2008
Last Update Date	:	03/17/2018

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Directions to “ ERNEST U AMUKAMARA ” Practice Location

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