Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 89076 | GA |
NPI | 1255759627 |
---|---|
Provider Name | Chisom Ezenekwe |
First Address | North Charleston, SC 29418-3067 |
Second Address | North Charleston, SC 29418-3067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 30/09/2021 |