Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2005-00555 | NC |
N | 111NI0900X | Internist | 2005-00555 | NC |
N | 207RC0000X | Internist - Cardiovascular Disease | 2005-00555 | NC |
Y | 207RI0011X | Interventional Cardiology | 70218 | GA |
NPI | 1043346893 |
---|---|
Provider Name | Christopher O. Ike |
First Address | Macon, GA 31208-6135 |
Second Address | Macon, GA 31201-2851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 28/03/2014 |