Basic Information
| Provider Information | |||||||||
| NPI: | 1255335584 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EKE | ||||||||
| FirstName: | IFEOMA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 5080 PEACHTREE BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CHAMBLEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303412877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047855437 | ||||||||
| FaxNumber: | 4047858053 | ||||||||
| Practice Location | |||||||||
| Address1: | 5080 PEACHTREE BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CHAMBLEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303412877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047855437 | ||||||||
| FaxNumber: | 4047858053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 06/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 52350 | GA | Y | Other Service Providers | Specialist |
No ID Information.