Eno N Ikoku, M.D. – Military Health Care Provider

Key facts

NPI: 1376744946
Entity type: Individual (NPI type 1)
Primary specialty: Military Health Care Provider 171000000X
License: 30942 (GA)
Practice address: 1500 Hood Avenue
Building 720
Fort Gillem, GA 30297-5000
Phone: (404) 469-3090
NPI assigned: May 30, 2007
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Kingsley Agbeyegbe MD Internal Medicine Physician · East Point, GA · NPI 1790898773

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
30942	GA	MD	Military Health Care Provider

Practice roles

Organization	Specialty	Status	New patients
Kingsley Agbeyegbe MD		Past	Accepting new patients

Interoperability endpoints

FHIR API: https://fhir-myrecord.cerner.com/r4/20f03d9b-a36a-4840-9108-358bfe8520a9/

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Military Health Care Provider	171000000X	30942	GA	Yes

Addresses

Primary practice location

1500 Hood Avenue
Building 720
Fort Gillem, GA 30297-5000

Mailing address

7256 Iverson TRL
Lithonia, GA 30058-9019
Phone (770) 482-7636

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.