Ellis Ifeanyichukwu Efobi, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

060727 Issued in GA

Practice address

1525 E. Park Place Blvd.
Suite 300
Stone Mountain, GA 30087-3453

Phone

(770) 879-7707

Fax

(770) 879-7708

NPI assigned

May 19, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Access Medical Clinic Georgia LLC

  • Family Medicine Physician
  • Perry, GA
  • NPI 1730793639
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296604800000",
    "number": "1144487018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 E. PARK PLACE BLVD.",
            "address_2": "SUITE 300",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873453",
            "telephone_number": "770-879-7707",
            "fax_number": "770-879-7708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 E. PARK PLACE BLVD.",
            "address_2": "SUITE 300",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300873453",
            "telephone_number": "770-879-7707",
            "fax_number": "770-879-7708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EFOBI",
        "first_name": "ELLIS",
        "middle_name": "IFEANYICHUKWU",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-19",
        "last_updated": "2011-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "060727",
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "GA",
            "license": "060727",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "594981959A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Diann Eddins
• Edward Edeh, PHARM D
• Edward M. Gotlieb, M.D., Et Al Dba the Pediatric Center
• Denise Edwards, PT
• Wanda Faye Edwards, LPN
• Ehi Pharmacy Solutions, LLC.
• Joy U Ekam
• Elite Care Angels Inc
• Marleen Ellegor, MSW
• Antoinette Elliott

• General Practice Physician in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.