Provider Demographics
NPI:1679292650
Name:AHANOTU, GILBERT EMMANUEL
Entity Type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:EMMANUEL
Last Name:AHANOTU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 ANDERSON RD UNIT 20
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-2754
Mailing Address - Country:US
Mailing Address - Phone:601-506-7759
Mailing Address - Fax:
Practice Address - Street 1:2405 ANDERSON RD UNIT 20
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-2754
Practice Address - Country:US
Practice Address - Phone:601-506-7759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program