Provider Demographics
NPI:1508521816
Name:IGBO, NKECHI FAITH
Entity Type:Individual
Prefix:
First Name:NKECHI
Middle Name:FAITH
Last Name:IGBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 WESTCHESTER LN NE # 2311
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-2541
Mailing Address - Country:US
Mailing Address - Phone:404-839-6470
Mailing Address - Fax:
Practice Address - Street 1:3626 OLD OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2805
Practice Address - Country:US
Practice Address - Phone:770-503-9285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF07210914363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily