Individual
NNE-NA EZEABASILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1365 CLIFTON RD NE, ATLANTA, GA 30322-4109
(404) 992-2286
Mailing address
1365 CLIFTON RD NE, ATLANTA, GA 30322-0001
(404) 992-2286
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10688
GA
363A00000X
Physician Assistant
50.007616RX
OH
Other
Enumeration date
05/01/2020
Last updated
04/24/2024
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