Provider Demographics
NPI:1306152871
Name:IWOTOR, ESTHER IJEOMA (NP - C)
Entity type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:IJEOMA
Last Name:IWOTOR
Suffix:
Gender:F
Credentials:NP - C
Other - Prefix:MRS
Other - First Name:ESTHER
Other - Middle Name:IJEOMA
Other - Last Name:NKENKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNP
Mailing Address - Street 1:257 VININGS RETREAT VW SW
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2574
Mailing Address - Country:US
Mailing Address - Phone:770-948-6767
Mailing Address - Fax:
Practice Address - Street 1:6031 FAIRBURN RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2307
Practice Address - Country:US
Practice Address - Phone:404-616-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARNP109484363LF0000X
GANP109484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily