Provider Demographics
NPI:1124119219
Name:ATEKHA, COURAGE A (MD)
Entity type:Individual
Prefix:MR
First Name:COURAGE
Middle Name:A
Last Name:ATEKHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 BERMUDA RUN
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0858
Mailing Address - Country:US
Mailing Address - Phone:912-764-8396
Mailing Address - Fax:912-764-7188
Practice Address - Street 1:1030 BERMUDA RUN
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0858
Practice Address - Country:US
Practice Address - Phone:912-764-8396
Practice Address - Fax:912-764-7188
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049266207RN0300X, 2472R0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal Dialysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000933413K,L,M,N,O,PMedicaid
GAH33326Medicare UPIN
GA39BDCLG/ GRP7175Medicare ID - Type Unspecified