Provider Demographics
NPI:1629947247
Name:IFEADIKE, NNEAMAKA
Entity type:Individual
Prefix:
First Name:NNEAMAKA
Middle Name:
Last Name:IFEADIKE
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11130 MEDLOCK BRIDGE RD APT 1110
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8502
Mailing Address - Country:US
Mailing Address - Phone:404-567-6214
Mailing Address - Fax:
Practice Address - Street 1:105 PILGRIM VILLAGE DR STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2583
Practice Address - Country:US
Practice Address - Phone:678-395-3269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-03
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP013059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist