Provider Demographics
NPI:1023715844
Name:ESOCHAGHI, AHAOMA
Entity type:Individual
Prefix:
First Name:AHAOMA
Middle Name:
Last Name:ESOCHAGHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 CODY DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-8211
Mailing Address - Country:US
Mailing Address - Phone:267-455-2960
Mailing Address - Fax:
Practice Address - Street 1:223 2ND ST E STE B
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-0410
Practice Address - Country:US
Practice Address - Phone:229-339-3721
Practice Address - Fax:229-472-9151
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2025-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN333757363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health