Individual
MELVIN CHIZOBA EZEOKONKWO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8162 BIRCH WALK DR, RIVERDALE, GA 30274-7116
(770) 912-4515
Mailing address
8162 BIRCH WALK DR, RIVERDALE, GA 30274-7116
(770) 912-4515
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/07/2020
Last updated
02/07/2020
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