Provider Demographics
NPI:1255335584
Name:EKE, IFEOMA (MD)
Entity type:Individual
Prefix:
First Name:IFEOMA
Middle Name:
Last Name:EKE
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 1:5080 PEACHTREE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2877
Mailing Address - Country:US
Mailing Address - Phone:404-785-5437
Mailing Address - Fax:404-785-8053
Practice Address - Street 1:5080 PEACHTREE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-2877
Practice Address - Country:US
Practice Address - Phone:404-785-5437
Practice Address - Fax:404-785-8053
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA52350174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA980268974AMedicaid
GAH80406Medicare UPIN
GA980268974AMedicaid