Individual
BASIL EZENWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
616 19TH ST, COLUMBUS, GA 31901-1528
(904) 805-1300
(904) 805-1302
Mailing address
PO BOX 532724, ATLANTA, GA 30353-2724
(904) 805-1300
(904) 805-1302
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
37797
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000580082D
—
GA
05
—
009922855
—
AL
01
—
616430
BLUE CROSS
GA
Enumeration date
06/16/2006
Last updated
03/19/2008
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