Alexander Chukwuma Ibezi-Enendu, D.O.
Individual provider Active NPI Family Medicine Physician · Unadilla, GA
NPI 1154615979 · NPPES record last updated Nov 18, 2023
Key facts
- NPI
- 1154615979
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 75636 (GA)
- Practice address
- 2809 Pine St
Unadilla, GA 31091-7701 - Phone
- (478) 355-3000
- Fax
- (478) 355-3001
- NPI assigned
- Jun 9, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Philadelphia College of Osteopathic Medicine, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2809 Pine St
Unadilla, GA 31091-7701
Phone (478) 355-3000
Hospital & facility affiliations
- Taylor Regional Hospital
- Emory Houston Hospital Warner Robins
- Bleckley Memorial Hospital
- Crisp Regional Hospital
- Taylor Regional Hospital
- Fort Valley Crossing of Journey LLC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160706002548 | GA | Practitioner - Family Practice |
3274832894 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101019441 | MI | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Optimus Diagnostics LLC | Current | Accepting new patients | |
| Malozera Primary Care, LLC | Family Medicine | Current |
Accepting new patients |
| Piedmont Sports Medicine & Orthopaedic Clinic, PC | Past |
Accepting new patients | |
| Fort Valley Operator LLC | Past | Accepting new patients |
Locations
604 N Camellia Blvd
Fort Valley, GA 31030
Phone (478) 355-3000
1005 Boulder Dr
Gray, GA 31032
Phone (478) 621-2072
292 Industrial Blvd
Ste 300
Hawkinsville, GA 31036
Phone (478) 783-3610
200 S Kimberly Rd
Warner Robins, GA 31088
Phone (478) 293-4900
Interoperability endpoints
- alexander.ibezi-enendu.1@15130.direct.athenahealth.com
- alexanderibezi-enendu@trh.allscriptsdirect.net
- https://fhir4.healow.com/fhir/r4/CHGJBD/Endpoint/CHGJBD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 5101019441 | MI | |
| Family Medicine Physician | 207Q00000X | 75636 | GA | Yes |
Addresses
Primary practice location
2809 Pine St
Unadilla, GA 31091-7701
Mailing address
P O Box 8203
Warner Robins, GA 31095-8203
Phone (478) 355-3000
Other practice location 1
222 Perry Hwy
Hawkinsville, GA 31036-6748
Phone (478) 783-4887
Other practice location 2
604 Bluebird Blvd
Fort Valley, GA 31030-5081
Phone (478) 825-2031
Other practice location 3
200 S Kimberly Rd
Warner Robins, GA 31088-8721
Phone (478) 293-4900
Other practice location 4
292 Industrial Blvd Ste 300
Hawkinsville, GA 31036-8034
Phone (478) 783-3610
Other practice location 5
801 Elberta Rd
Warner Robins, GA 31093-1735
Phone (478) 923-3146
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003167544B | Medicaid | GA |
Other providers in Unadilla, GA
- Easy Living Care Home Inc
- Eugene Emory
- Tabatha Turner Hardwick
- Healthcare of Unadilla LLC
- Alicia Henderson
- Kimberly Crump Johnson
- Kristie Lashawn Lawson
- Leisure Life Care Home Inc
- Malozera Primary Care, LLC
- Laquish Denise Martin
All providers in Unadilla, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.