=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063473569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES CHIKE EZI-ASHI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2006
-----------------------------------------------------
Last Update Date | 05/26/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 438 N WHITNEY AVE
-----------------------------------------------------
City | COOKEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-783-2616
-----------------------------------------------------
Fax | 931-783-2610
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 W 7TH ST
-----------------------------------------------------
City | COOKEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38501-1726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-783-5582
-----------------------------------------------------
Fax | 931-526-6760
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | MD417825
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RI0008X
-----------------------------------------------------
Taxonomy Name | Hepatology Physician
-----------------------------------------------------
License Number | MD417825
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | 58011
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------