Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD.38435 | AL |
N | 207Q00000X | Family Doctor | 007739 | GA |
N | 207Q00000X | Family Doctor | 078444 | GA |
Y | 207Q00000X | Family Doctor | 78444 | GA |
N | 207QA0505X | Family Doctor - Adult Medicine | 78444 | GA |
NPI | 1336534122 |
---|---|
Provider Name | Promise Chidi |
First Address | Columbus, GA 31901-3600 |
Second Address | Columbus, GA 31901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2015 |
Last Update Date | 26/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
078444 | GEORGIA LICENCE (01) | GA |