Provider Demographics
NPI:1962499137
Name:AMPIAW, EUNICE A (MD)
Entity Type:Individual
Prefix:DR
First Name:EUNICE
Middle Name:A
Last Name:AMPIAW
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 9247
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-9247
Mailing Address - Country:US
Mailing Address - Phone:706-322-7884
Mailing Address - Fax:706-660-2118
Practice Address - Street 1:860 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9270
Practice Address - Country:US
Practice Address - Phone:706-507-5320
Practice Address - Fax:706-507-4741
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000876631FMedicaid
GA20208I1191OtherMEDICARE PTAN
GAP01367069OtherRAILROAD MEDICARE
GA08BBTJKMedicare PIN
GAP01367069OtherRAILROAD MEDICARE