Mariagorrathy Nkiru Ejike

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN221552 Issued in GA

Practice address

6224 Heavenwood Way
Douglasville, GA 30135-5658

Phone

(404) 934-6981

NPI assigned

May 6, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1557100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702252800000",
    "number": "1740845635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6224 HEAVENWOOD WAY",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301355658",
            "telephone_number": "404-934-6981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6224 HEAVENWOOD WAY",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301355658",
            "telephone_number": "404-934-6981"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1842 S Carisbrook Pl",
            "address_purpose": "LOCATION",
            "city": "Austell",
            "state": "GA",
            "postal_code": "301685139",
            "country_code": "US",
            "telephone_number": "404-934-6981",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EJIKE",
        "first_name": "MARIAGORRATHY",
        "middle_name": "NKIRU",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-06",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN221552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Edwards
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• William Carlton Edwards Sr., O.D.
• Egreen Enterprises, Inc
• Ehi Pharmacy Solutions, LLC.
• Ihuoma Joyce Ejisoby
• Amalachukwu Eke-Okoro
• Odinakachi Eke-Okoro
• Rafiq M. El Hammali, MD
• Khaled Elchoufi

• Family Nurse Practitioner in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.