Provider Demographics
NPI:1235340415
Name:EKEKHOMEN, GODWIN ILEGBEDION (OD)
Entity Type:Individual
Prefix:DR
First Name:GODWIN
Middle Name:ILEGBEDION
Last Name:EKEKHOMEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 OAKLAND SPRING DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-7956
Mailing Address - Country:US
Mailing Address - Phone:404-735-9513
Mailing Address - Fax:770-498-3440
Practice Address - Street 1:2205 OAKLAND SPRING DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-7956
Practice Address - Country:US
Practice Address - Phone:404-735-9513
Practice Address - Fax:770-498-3440
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002372152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist