Provider Demographics
NPI:1568235661
Name:LEKEAKA, ACHANGWO MARY (FNP)
Entity Type:Individual
Prefix:
First Name:ACHANGWO
Middle Name:MARY
Last Name:LEKEAKA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ACHANGWO
Other - Middle Name:MARY
Other - Last Name:LEKEAKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1599 SCHOOL HOUSE RUN
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7805
Mailing Address - Country:US
Mailing Address - Phone:706-308-5012
Mailing Address - Fax:
Practice Address - Street 1:180 EPPS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3312
Practice Address - Country:US
Practice Address - Phone:706-549-5382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN260257363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily