Individual
IVIE B EKHORUTOMWEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
110 WALTER WAY UNIT 2635, STOCKBRIDGE, GA 30281-9526
(404) 692-0232
Mailing address
889 KENT CT, LITHONIA, GA 30058-8240
(413) 204-4729
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN296248
GA
Other
Enumeration date
04/14/2025
Last updated
04/14/2025
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