MEDICARE: DR. COLE EZEOKE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	042819	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437144003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLE EZEOKE MD

Provider Business Mailing Address
First Line	:	1575 CHATTANOOGA AVE
Second Line	:	SUITE 1
City	:	DALTON
State	:	GA
Zip	:	30720-2671
Country	:	US
Telephone Number	:	706-876-2130
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 CHATTANOOGA AVE
Second Line	:	SUITE 1
City	:	DALTON
State	:	GA
Zip	:	30720-2671
Country	:	US
Telephone Number	:	706-876-2130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	03/16/2011

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Directions to “ DR. COLE EZEOKE MD” Practice Location

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