Provider Demographics
NPI:1376744946
Name:IKOKU, ENO N (MD)
Entity Type:Individual
Prefix:DR
First Name:ENO
Middle Name:N
Last Name:IKOKU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7256 IVERSON TRL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-9019
Mailing Address - Country:US
Mailing Address - Phone:770-482-7636
Mailing Address - Fax:
Practice Address - Street 1:1500 HOOD AVENUE
Practice Address - Street 2:BUILDING 720
Practice Address - City:FORT GILLEM
Practice Address - State:GA
Practice Address - Zip Code:30297-5000
Practice Address - Country:US
Practice Address - Phone:404-469-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30942171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider