Healthcare Provider Details

I. General information

NPI: 1154663664
Provider Name (Legal Business Name): UGOCHI GUCCI EZEALA M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1570 HOLCOMB BRIDGE RD STE 510
ROSWELL GA
30076-2596
US

IV. Provider business mailing address

1570 HOLCOMB BRIDGE RD STE 510
ROSWELL GA
30076-2596
US

V. Phone/Fax

Practice location:
  • Phone: 470-210-2375
  • Fax: 470-210-2377
Mailing address:
  • Phone: 470-210-2375
  • Fax: 470-210-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number054947
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81452
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: