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General NPI Number Information
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NPI Number | 1669590725
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Entity Type | Organization
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Legal Business Name | CHRISTIAN M EZEKWUECHE
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 770 PINE ST SUITE 560
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City | MACON
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State | GA
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Zip | 31201-2173
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Country | US
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Telephone | 478-741-5155
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Fax | 478-746-9682
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Provider Business Mailing Address
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Address Line | 770 PINE ST SUITE 560
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City | MACON
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State | GA
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Zip | 31201-2173
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Country | US
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Telephone | 478-741-5155
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Fax | 478-746-9682
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS PANETTA BROWN
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Credential |
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Telephone | 478-741-5155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 056574
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 024808
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License Number State | GA
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