Healthcare Provider Details

I. General information

NPI: 1629538509
Provider Name (Legal Business Name): MRS. CHIKA NGOZI EZENEKWE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

4935 NOTTING GLEN LN
SNELLVILLE GA
30039-3333
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-1000
  • Fax:
Mailing address:
  • Phone: 404-372-8848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRN227131
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: