Provider Demographics
NPI:1275068173
Name:AGBOR, EBANGA (NP)
Entity Type:Individual
Prefix:
First Name:EBANGA
Middle Name:
Last Name:AGBOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12389 CRABAPPLE RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6328
Mailing Address - Country:US
Mailing Address - Phone:470-299-1998
Mailing Address - Fax:470-299-1898
Practice Address - Street 1:12389 CRABAPPLE RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6328
Practice Address - Country:US
Practice Address - Phone:470-299-1998
Practice Address - Fax:470-299-1898
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN226655363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner