Active NPI
Christian Ezeagwu
- Pharmacist
- Fayetteville, GA
National Provider Identifier
1023317583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 014472
- Practice address
- 150 Bramblebush Chase
Fayetteville, GA 30214-2670 - Phone
- (770) 716-1295
- NPI assigned
- Mar 23, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 014472 | GA | Primary |
Addresses
Primary practice location
150 Bramblebush Chase
Fayetteville, GA 30214-2670
Mailing address
833 Forest Pkwy
Forest Park, GA 30297-2210
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014472 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300838400000",
"number": "1023317583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "833 FOREST PKWY",
"city": "FOREST PARK",
"state": "GA",
"postal_code": "302972210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 BRAMBLEBUSH CHASE",
"city": "FAYETTEVILLE",
"state": "GA",
"postal_code": "302142670",
"telephone_number": "770-716-1295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EZEAGWU",
"first_name": "CHRISTIAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-03-23",
"last_updated": "2011-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "014472",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.