Provider Demographics
NPI:1083497606
Name:FONKIKA, LOVELIN
Entity Type:Individual
Prefix:
First Name:LOVELIN
Middle Name:
Last Name:FONKIKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOVELIN
Other - Middle Name:
Other - Last Name:NGWONJOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:129 EWING WAY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-5601
Mailing Address - Country:US
Mailing Address - Phone:140-443-7231
Mailing Address - Fax:
Practice Address - Street 1:6650 SUGARLOAF PKWY STE 800
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4359
Practice Address - Country:US
Practice Address - Phone:404-921-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN280842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily