1114456316 NPI number — MRS. MERCY A. EKPOUDOM R.N.

Table of content: MRS. MERCY A. EKPOUDOM R.N. (NPI 1114456316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114456316 NPI number — MRS. MERCY A. EKPOUDOM R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EKPOUDOM
Provider First Name:
MERCY
Provider Middle Name:
A.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AMASOWOMWAN
Provider Other First Name:
EDNA
Provider Other Middle Name:
I.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.N.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1114456316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 SAINT PAULS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOCKBRIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30281-1093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-608-7151
Provider Business Mailing Address Fax Number:
678-289-9256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 SAINT PAULS CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281-1093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-608-7151
Provider Business Practice Location Address Fax Number:
678-289-9256
Provider Enumeration Date:
06/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X , with the licence number:  RN109319 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RN109319 . This is a "NURSING LICENSE NO" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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