Individual provider · Type 1 NPI
Eno N. Ikoku, MD
Military Health Care Provider · Fort Gillem, GA
NPI number
1376744946
Active
Practice location
1500 Hood Avenue, Building 720
Fort Gillem, GA 30297-5000
Mailing address
7256 Iverson Trl
Lithonia, GA 30058-9019
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Military Health Care Provider Primary | 171000000X | 30942 (GA) |
Military Health Care Provider: Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
About NPI 1376744946
Eno N. Ikoku, MD's National Provider Identifier is 1376744946, issued on May 30, 2007. The primary taxonomy on file is Military Health Care Provider (171000000X), and the practice location is in Fort Gillem, GA. The record was last updated on Jul 8, 2007.