Provider Demographics
NPI:1871750539
Name:EZEH, NGOZI IHEUWA (MD, RPA-C)
Entity type:Individual
Prefix:DR
First Name:NGOZI
Middle Name:IHEUWA
Last Name:EZEH
Suffix:
Gender:F
Credentials:MD, RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 THE MASTERS CV
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-6005
Mailing Address - Country:US
Mailing Address - Phone:478-257-6672
Mailing Address - Fax:
Practice Address - Street 1:3780 EISENHOWER PKWY
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-0800
Practice Address - Country:US
Practice Address - Phone:478-633-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003567207Q00000X
NY006375-1363AS0400X
NJ25MP00054000363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical