MEDICARE: PRINCE EJINDU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	74822	TN
2	2083X0100X	Occupational Medicine Physician	90543	SC
3	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	V6920	TX
4	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	2025-02985	NC

General Provider Information

NPI Number	:	1215558812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRINCE EJINDU MD

Provider Business Mailing Address
First Line	:	7428 BRADY LN
Second Line	:
City	:	ANTIOCH
State	:	TN
Zip	:	37013-5177
Country	:	US
Telephone Number	:	615-719-4514
Fax Number	:	868-644-4816

Provider Business Practice Location Address
First Line	:	460 KING ST STE 200
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29403-6229
Country	:	US
Telephone Number	:	615-719-4514
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2020
Last Update Date	:	03/02/2026

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Directions to “ PRINCE EJINDU MD” Practice Location

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