Provider Demographics
NPI:1629037973
Name:ENIN, NAABEA (MD)
Entity Type:Individual
Prefix:
First Name:NAABEA
Middle Name:
Last Name:ENIN
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 336
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-0336
Mailing Address - Country:US
Mailing Address - Phone:478-448-1919
Mailing Address - Fax:
Practice Address - Street 1:1112 PLAZA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-9009
Practice Address - Country:US
Practice Address - Phone:478-448-1919
Practice Address - Fax:478-448-1916
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055668207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BBDBBMedicare ID - Type UnspecifiedMEDICARE
GAI49790Medicare UPIN