Provider Demographics
NPI:1346059920
Name:EKANEM, TOMA OSAMA (NP)
Entity type:Individual
Prefix:
First Name:TOMA
Middle Name:OSAMA
Last Name:EKANEM
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:TOMA
Other - Middle Name:OSAMA
Other - Last Name:AIHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7506 GWINETT ST APT B
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31315-5715
Mailing Address - Country:US
Mailing Address - Phone:617-586-6977
Mailing Address - Fax:
Practice Address - Street 1:109 W. OGLETHORPE HWY.
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-368-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-07
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN299457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1190694OtherSTATE-ISSUED ADVANCED PRACTICE - NP LICENSE NUMBER
GARN299457OtherSTATE-ISSUED ADVANCED PRACTICE - NP LICENSE NUMBER