Provider Demographics
NPI:1316387202
Name:AMEVOR, ANTOINETTE ADJOWA OTUBEA (MD)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:ADJOWA OTUBEA
Last Name:AMEVOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANTOINETTE
Other - Middle Name:
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1062 FORSYTH ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8631
Mailing Address - Country:US
Mailing Address - Phone:478-633-7330
Mailing Address - Fax:478-633-7360
Practice Address - Street 1:1062 FORSYTH ST STE 2E
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8631
Practice Address - Country:US
Practice Address - Phone:478-633-7330
Practice Address - Fax:478-633-7360
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA75702208000000X, 2080P0206X
GA6596208000000X
OH35.1364782080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics