Individual
IDORENYIN EKA-IMO NDEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1001 JOHNSON FERRY RD, ATLANTA, GA 30342-1605
(404) 785-7792
Mailing address
975 JOHNSON FERRY RD STE 100, ATLANTA, GA 30342-1618
(404) 785-7792
(919) 966-3814
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
100641
GA
390200000X
Student in an Organized Health Care Education/Training Program
238506
NC
Other
Enumeration date
05/16/2018
Last updated
07/08/2024
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