Provider Demographics
NPI:1144858143
Name:DIKE, NWAMAKA (MD)
Entity type:Individual
Prefix:DR
First Name:NWAMAKA
Middle Name:
Last Name:DIKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BANKS STA
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7507
Mailing Address - Country:US
Mailing Address - Phone:301-412-5216
Mailing Address - Fax:
Practice Address - Street 1:1975 HIGHWAY 54 W STE 150
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4795
Practice Address - Country:US
Practice Address - Phone:770-486-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA95945207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine