Provider Demographics
NPI:1659577484
Name:EKPENIKE, ANTHONIA OBIAGERI (MBBS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONIA
Middle Name:OBIAGERI
Last Name:EKPENIKE
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:DR
Other - First Name:ANTHONIA
Other - Middle Name:OBIAGERI
Other - Last Name:OKOJIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:400 W PEACHTREE ST NW
Mailing Address - Street 2:UNIT 1116
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3536
Mailing Address - Country:US
Mailing Address - Phone:732-822-9481
Mailing Address - Fax:
Practice Address - Street 1:11 UPPER RIVERDALE RD SW
Practice Address - Street 2:SOUTHERN REGIONAL MEDICAL CENTER
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2615
Practice Address - Country:US
Practice Address - Phone:770-991-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200619920AMedicaid
KS200677910CMedicaid
MO1659577484Medicaid
KS200677910CMedicaid