Provider Demographics
NPI:1447417373
Name:UMANA, IDOPISE E (MD)
Entity Type:Individual
Prefix:
First Name:IDOPISE
Middle Name:E
Last Name:UMANA
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:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:770-219-8440
Practice Address - Street 1:5875 THOMPSON MILL RD
Practice Address - Street 2:STE. 200
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-848-6140
Practice Address - Fax:770-848-6141
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96600207R00000X
GA062295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA412501237AMedicaid
FL000271500Medicaid
FLAM252ZMedicare PIN