Provider Demographics
NPI:1356529101
Name:AMUKAMARA, ERNEST U
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:U
Last Name:AMUKAMARA
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 1:5615 OLD NATIONAL HWY. SUITE D
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3244
Mailing Address - Country:US
Mailing Address - Phone:770-997-2900
Mailing Address - Fax:678-949-9310
Practice Address - Street 1:5615 OLD NATIONAL HWY STE D
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-3817
Practice Address - Country:US
Practice Address - Phone:770-997-2900
Practice Address - Fax:678-949-9310
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201832NP363LF0000X
NJ26NJ00153300363LF0000X
GARN201832 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1548431091Other982 BROAD STREET
NJ1932370483Other101 LUDLOW STREET
NJ1972778413Other1150 SPRINGFIELD AVENUE
NJ1235300799Other37 N DAY
NJ1194996645Other444 WILLIAM STREET
NJ1740345693Other741 BROADWAY
NJ222747589OtherNCHC TAX ID
NJ1740345693Other741 BROADWAY