Healthcare Provider Details

I. General information

NPI: 1033645734
Provider Name (Legal Business Name): ECHEZONA GERALD NSOFOR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date: 12/06/2017
Reactivation Date: 06/04/2018

III. Provider practice location address

14 RICHLAND MEDICAL PARK DR STE 320
COLUMBIA SC
29203-6896
US

IV. Provider business mailing address

PO BOX 23321
NEW YORK NY
10087-3321
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6771
  • Fax: 803-434-3995
Mailing address:
  • Phone: 207-317-7704
  • Fax: 662-222-5277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2025-00450
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number83514
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number83514
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: