Organization
CHRISTIAN M EZEKWUECHE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS PANETTA BROWN (OFFICE MANAGER)
(478) 741-5155
Entity
Organization
Contact information
Practice address
770 PINE ST, SUITE 560, MACON, GA 31201-2173
(478) 741-5155
(478) 746-9682
Mailing address
770 PINE ST, SUITE 560, MACON, GA 31201-2173
(478) 741-5155
(478) 746-9682
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
024808
GA
174400000X
Specialist
056574
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00259949A
—
GA
Enumeration date
03/27/2007
Last updated
08/22/2020
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