Healthcare Provider Details

I. General information

NPI: 1144154121
Provider Name (Legal Business Name): CHIKA JUSTICE EZEOKONKWO PT,DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 CHATTAHOOCHEE DR
ROCKMART GA
30153-2023
US

IV. Provider business mailing address

8162 BIRCH WALK DR
RIVERDALE GA
30274-7116
US

V. Phone/Fax

Practice location:
  • Phone: 706-509-3683
  • Fax:
Mailing address:
  • Phone: 770-896-4121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018294
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: