Provider Demographics
NPI:1871769521
Name:PRINCEWILL EHIRIM MD PC
Entity type:Organization
Organization Name:PRINCEWILL EHIRIM MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PRINCEWILL
Authorized Official - Middle Name:
Authorized Official - Last Name:EHIRIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-916-7053
Mailing Address - Street 1:500 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-8708
Mailing Address - Country:US
Mailing Address - Phone:678-916-7053
Mailing Address - Fax:678-826-0867
Practice Address - Street 1:500 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-8708
Practice Address - Country:US
Practice Address - Phone:678-916-7053
Practice Address - Fax:678-826-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty