Provider Demographics
NPI:1134365810
Name:LEKE-TAMBO, AWUNGJIA CAMERICA (MD)
Entity type:Individual
Prefix:DR
First Name:AWUNGJIA
Middle Name:CAMERICA
Last Name:LEKE-TAMBO
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 1:3320 OLD JEFFERSON RD
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1400
Mailing Address - Country:US
Mailing Address - Phone:706-549-5560
Mailing Address - Fax:706-353-0636
Practice Address - Street 1:3320 OLD JEFFERSON RD
Practice Address - Street 2:SUITE 200A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1400
Practice Address - Country:US
Practice Address - Phone:706-549-5560
Practice Address - Fax:706-353-0636
Is Sole Proprietor?:No
Enumeration Date:2008-12-30
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS33964207RC0200X
NJ25IA12381000207RC0200X
GA067803207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA067803OtherLICENSE
NJ25IA12381000OtherLICENSE
MS33964OtherLICENSE
GA003127568AMedicaid