# MALOZERA PRIMARY CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912544784
- **Authorized official:** DR. ALEXANDER C IBEZI-ENENDU DO (OWNER)
- **Authorized official phone:** (404) 702-9466

## Contact information

- **Practice address:** 2809 PINE ST, UNADILLA, GA 31091-7701
- **Practice address phone:** (478) 355-3000
- **Practice address fax:** (478) 355-3001
- **Mailing address:** P O BOX 8203, WARNER ROBINS, GA 31095-8203
- **Mailing address phone:** (478) 783-3610
- **Mailing address fax:** (478) 783-3611

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/29/2019
- **Last updated:** 11/18/2023