Individual
DR. ELLIS IFEANYICHUKWU EFOBI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1525 E. PARK PLACE BLVD., SUITE 300, STONE MOUNTAIN, GA 30087-3453
(770) 879-7707
(770) 879-7708
Mailing address
1525 E. PARK PLACE BLVD., SUITE 300, STONE MOUNTAIN, GA 30087-3453
(770) 879-7707
(770) 879-7708
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
060727
GA
208D00000X
General Practice Physician
Primary
060727
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
594981959A
—
GA
Enumeration date
05/19/2008
Last updated
02/02/2011
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