Provider Demographics
NPI:1538937818
Name:AMANJI LLC
Entity type:Organization
Organization Name:AMANJI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:EZUKANMA
Authorized Official - Suffix:
Authorized Official - Credentials:PHMNP-BC
Authorized Official - Phone:817-980-5659
Mailing Address - Street 1:9908 LAMBERTON TER
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8514
Mailing Address - Country:US
Mailing Address - Phone:817-980-5659
Mailing Address - Fax:917-722-1713
Practice Address - Street 1:9908 LAMBERTON TER
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8514
Practice Address - Country:US
Practice Address - Phone:817-980-5659
Practice Address - Fax:917-722-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-15
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty