Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Enoma Evbuomwan

Individual provider Medical Physician Assistant · NPI 1578954640

Enoma Evbuomwan is a Physician Assistant in Mableton, Georgia. Qualified in 2014, 12 years ago. Practices with Wellstreet of Georgia PC, a 431-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Georgia.

Years since qualifying
12
Licensed in
GA
In the registry since
2015
Specialties on file
2

Practice location Address checks out

1400 Veterans Memorial Hwy SE # 563
Mableton, GA 30126-2945
Phone: (470) 600-8494
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 500 Nathan Dean Blvd Ste 105, Dallas, GA 30157-4911 — (470) 624-6792

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 007457 (GA)
Medical Physician Assistant Taxonomy 363AM0700X

Record details

NPI number1578954640
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedFebruary 11, 2015
Last updated in NPPESMarch 17, 2026
Certification dateMarch 17, 2026
Mailing address4519 Woodruff Rd Ste 4, Columbus, GA 31904-6096

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Wellstreet Of Georgia Pc — 431 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare