MEDICARE: JOY CHIDINMA EZUMA

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	363L00000X	Nurse Practitioner	RN211803	GA

General Provider Information

NPI Number	:	1932601143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY CHIDINMA EZUMA

Provider Business Mailing Address
First Line	:	1459 BELLEMEADE FARMS RD SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30008-3857
Country	:	US
Telephone Number	:	404-579-7264
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 E WEST CONNECTOR STE 106
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-6848
Country	:	US
Telephone Number	:	770-941-0010
Fax Number	:

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

Provider Enumeration Date	:	03/03/2018
Last Update Date	:	03/03/2018

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