Provider Demographics
NPI:1073832598
Name:ESSIENUMOH, NSIKAK ALEX (DPT)
Entity Type:Individual
Prefix:DR
First Name:NSIKAK
Middle Name:ALEX
Last Name:ESSIENUMOH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3056 ANVIL BLOCK RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294
Mailing Address - Country:US
Mailing Address - Phone:404-366-8100
Mailing Address - Fax:404-366-8106
Practice Address - Street 1:3056 ANVIL BLOCK RD
Practice Address - Street 2:SUITE 118
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294
Practice Address - Country:US
Practice Address - Phone:404-366-8100
Practice Address - Fax:404-366-8106
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT9924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist