Provider Demographics
NPI:1073200424
Name:ESOMONYE, THEODORA CHIEMEKA (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORA
Middle Name:CHIEMEKA
Last Name:ESOMONYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GME 720 WESTVIEW DR, SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310
Mailing Address - Country:US
Mailing Address - Phone:404-756-1383
Mailing Address - Fax:404-756-1313
Practice Address - Street 1:GME 720 WESTVIEW DR, SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310
Practice Address - Country:US
Practice Address - Phone:404-756-1383
Practice Address - Fax:404-756-1313
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program