Healthcare Provider Details

I. General information

NPI: 1235791815
Provider Name (Legal Business Name): CHIDINMA PAMELLA EJIKEME MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 06/18/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 HIGHWAY 9 E STE 340
LITTLE RIVER SC
29566-8165
US

IV. Provider business mailing address

506 E CHEVES ST STE 202
FLORENCE SC
29506-2616
US

V. Phone/Fax

Practice location:
  • Phone: 843-390-8302
  • Fax: 843-390-8315
Mailing address:
  • Phone: 843-777-5091
  • Fax: 843-777-5572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number93732
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number93732
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number93732
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: