Provider Demographics
NPI:1396713459
Name:EYO, UNWANA AMAJAK (MD)
Entity type:Individual
Prefix:
First Name:UNWANA
Middle Name:AMAJAK
Last Name:EYO
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 4997
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-4997
Mailing Address - Country:US
Mailing Address - Phone:336-830-9192
Mailing Address - Fax:336-830-9192
Practice Address - Street 1:364 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5434
Practice Address - Country:US
Practice Address - Phone:336-629-7723
Practice Address - Fax:336-629-7723
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200301352207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89135TAMedicaid
NCP00222659OtherRAILROAD MEDICARE
NC135TAOtherBCBS
NC2021568DMedicare PIN
NC232009Medicare PIN
NC135TAOtherBCBS
NC89135TAMedicaid