Provider Demographics
NPI:1508520131
Name:ISHIEKWENE, MARTHA N (MA)
Entity Type:Individual
Prefix:MISS
First Name:MARTHA
Middle Name:N
Last Name:ISHIEKWENE
Suffix:
Gender:F
Credentials:MA
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 5010
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30302-5010
Mailing Address - Country:US
Mailing Address - Phone:404-413-6200
Mailing Address - Fax:404-413-6207
Practice Address - Street 1:140 DECATUR ST SE FL 11
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3204
Practice Address - Country:US
Practice Address - Phone:404-413-6200
Practice Address - Fax:404-413-6207
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program