Provider Demographics
NPI:1164273983
Name:ATABA, EMMANUEL JUNIOR
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:JUNIOR
Last Name:ATABA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7829 RIVERDALE RD APT T2
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-4014
Mailing Address - Country:US
Mailing Address - Phone:240-960-7049
Mailing Address - Fax:
Practice Address - Street 1:7829 RIVERDALE RD APT T2
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-4014
Practice Address - Country:US
Practice Address - Phone:240-960-7049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide