Provider Demographics
NPI:1619140761
Name:ESSIEN, EKAN IWOK (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:EKAN
Middle Name:IWOK
Last Name:ESSIEN
Suffix:
Gender:M
Credentials:MD, MPH
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 94771
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30377-1771
Mailing Address - Country:US
Mailing Address - Phone:678-390-5263
Mailing Address - Fax:
Practice Address - Street 1:5815 WINDWARD PKWY STE 205
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4202
Practice Address - Country:US
Practice Address - Phone:770-954-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061772208600000X
GA61772208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1619140761OtherN/A
SC1619140761OtherN/A
NM1619140761OtherN/A
OK1619140761OtherN/A
VA1619140761OtherN/A
WA1619140761OtherN/A