Individual provider Active NPI

Anthony Uba Ekwenchi, MD

  • Hospice and Palliative Medicine (Psychiatry & Neurology) Physician
  • Austell, GA
National Provider Identifier
1376765180
Registry record updated Dec 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084H0002X
License
038745 Issued in GA
Practice address
4585 Austell Rd
Austell, GA 30106-1921
Phone
(770) 948-9338
Fax
(770) 948-5556
NPI assigned
May 2, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 19, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Psychiatry & Neurology) Physician 2084H0002X 038745 GA Primary

Addresses

Primary practice location

4585 Austell Rd
Austell, GA 30106-1921

Mailing address

4585 Austell Rd
Austell, GA 30106-1921
Phone (770) 948-9338

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050401000409 GA Practitioner - Psychiatry 4789631789 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4585 Austell Rd
Austell, GA 30106-1921
Phone (770) 948-9338

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Katie Clinics, Inc CurrentSince Feb 2, 2005 Accepting new patients
Fulton County Mhddad Past Accepting new patients
Fulton County Mental Health Center Past Accepting new patients

Locations

4585 Austell Rd
Austell, GA 30106
Phone (770) 948-9338

4760 Austell Rd
Ste 3
Austell, GA 30106
Phone (678) 442-8525

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1376765180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4585 AUSTELL RD",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061921",
            "telephone_number": "770-948-9338",
            "fax_number": "770-948-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4585 AUSTELL RD",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061921",
            "telephone_number": "770-948-9338",
            "fax_number": "770-948-5556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EKWENCHI",
        "first_name": "ANTHONY",
        "middle_name": "UBA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-02",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084H0002X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Hospice and Palliative Medicine",
            "state": "GA",
            "license": "038745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austell, GA

Sources for this page

Verify at the official NPI Registry.