Active NPI
Mary O Ejifoma, N.P.
- Family Nurse Practitioner
- Kennesaw, GA
National Provider Identifier
1356329411
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- RN120872
- Practice address
- 3070 N Main St NW
Kennesaw, GA 30144-2756 - Phone
- (770) 420-1092
- NPI assigned
- Jan 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN120872 | GA | Primary |
Addresses
Primary practice location
3070 N Main St NW
Kennesaw, GA 30144-2756
Mailing address
3369 Buford Highway
Suite 810
Atlanta, GA 30329-3722
Phone (404) 321-4692
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN120872 | GA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436227200000",
"number": "1356329411",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3369 BUFORD HIGHWAY",
"address_2": "SUITE 810",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303293722",
"telephone_number": "404-321-4692",
"fax_number": "404-321-4366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3070 N MAIN ST NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301442756",
"telephone_number": "770-420-1092"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EJIFOMA",
"first_name": "MARY",
"middle_name": "O",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-08",
"last_updated": "2015-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "RN120872",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.