Provider Demographics
NPI:1255079018
Name:LONGONJE, PETER EFUFE (ACNP)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:EFUFE
Last Name:LONGONJE
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 CALIBRE XING NW STE 1126
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4104
Mailing Address - Country:US
Mailing Address - Phone:470-227-8130
Mailing Address - Fax:470-747-7588
Practice Address - Street 1:4450 CALIBRE XING NW STE 1126
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4104
Practice Address - Country:US
Practice Address - Phone:470-227-8130
Practice Address - Fax:470-747-7588
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN273684363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care