Provider Demographics
NPI:1770554446
Name:NGONE, EWANE (MD)
Entity type:Individual
Prefix:DR
First Name:EWANE
Middle Name:
Last Name:NGONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2030 DARTMOTH WAY
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-5860
Mailing Address - Country:US
Mailing Address - Phone:678-907-2086
Mailing Address - Fax:678-840-8742
Practice Address - Street 1:1002 OVERLOOK DRIVE
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-5804
Practice Address - Country:US
Practice Address - Phone:678-907-2086
Practice Address - Fax:678-840-8742
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055684207Q00000X
MDD59153207Q00000X
ALMD.25727207Q00000X
MO2002029292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H84201Medicare UPIN