Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 2021-02456 | NC |
Y | 207R00000X | Internist | 2021-02456 | NC |
Y | 111NI0900X | Internist | 2021-02456 | NC |
N | 207RG0100X | Gastroenterologist | 2021-02456 | NC |
NPI | 1104318831 |
---|---|
Provider Name | Spora Esunju |
First Address | Charlotte, NC 28205-5642 |
Second Address | Charlotte, NC 28205-5642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2018 |
Last Update Date | 07/01/2022 |