Provider Demographics
NPI:1902637051
Name:EMEKA, PROSPER C
Entity type:Individual
Prefix:MR
First Name:PROSPER
Middle Name:C
Last Name:EMEKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 BLUE JUNIPER CIR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6539
Mailing Address - Country:US
Mailing Address - Phone:770-369-7248
Mailing Address - Fax:
Practice Address - Street 1:339 BLUE JUNIPER CIR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6539
Practice Address - Country:US
Practice Address - Phone:770-369-7248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN312074163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty