Healthcare Provider Details

I. General information

NPI: 1720467624
Provider Name (Legal Business Name): CHIZOBA NGESINA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TEAMHEALTH 265 BROOKVIEW CENTRE WAY SUITE 400
KNOXVILLE TN
37919
US

IV. Provider business mailing address

1025 GRISSOM FARM RD
GARNER NC
27529-7001
US

V. Phone/Fax

Practice location:
  • Phone: 856-686-4368
  • Fax: 658-488-5368
Mailing address:
  • Phone: 919-561-8429
  • Fax:

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 Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2018016631
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.136844
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: