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Individual

MRS. IFEOMA EZEH OMOREGIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1404 RIVER PL STE 501, BRASELTON, GA 30517-5600
(770) 534-2020
(770) 534-8025
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
7186
GA
363AS0400X
Surgical Physician Assistant
7186
GA

Other

Enumeration date
08/04/2014
Last updated
12/08/2020
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