John Chinaka Ibemere, LPN

Key facts

NPI

1124468087

Entity type

Individual (NPI type 1)

Primary specialty

Licensed Practical Nurse 164W00000X

License

LPN076563 (GA)

Practice address

1670 Clairmont Rd
Decatur, GA 30033-4004

Phone

(404) 966-2483

NPI assigned

Jun 25, 2013

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 25, 2013.

{
    "created_epoch": "1372118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372118400000",
    "number": "1124468087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2535 CROOKED CREEK LN",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300353020",
            "telephone_number": "404-966-2483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 CLAIRMONT RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300334004",
            "telephone_number": "404-966-2483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBEMERE",
        "first_name": "JOHN",
        "middle_name": "CHINAKA",
        "name_prefix": "Mr.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-25",
        "last_updated": "2013-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "GA",
            "license": "LPN076563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPN",
            "identifier": "LPN076563",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Decatur, GA · Licensed Practical Nurse in Georgia