Healthcare Provider Details

I. General information

NPI: 1831541754
Provider Name (Legal Business Name): CHIAZOR EZIAKOR DNP, PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2016
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 BOULEVARD NE
ATLANTA GA
30312-1208
US

IV. Provider business mailing address

265 BOULEVARD NE
ATLANTA GA
30312-1208
US

V. Phone/Fax

Practice location:
  • Phone: 770-948-4512
  • Fax:
Mailing address:
  • Phone: 770-948-4512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06162151
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2019082358
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN189319
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: