Individual provider Active NPI

Damian Onyedikachi Ezuma, MD

  • Student in an Organized Health Care Education/Training Program
  • Gainesville, GA
National Provider Identifier
1508707183
Registry record updated Apr 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
743 Spring St NE Ste 710
Gainesville, GA 30501-3715
Phone
(770) 219-8730
NPI assigned
Apr 6, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X GA Primary

Addresses

Primary practice location

743 Spring St NE Ste 710
Gainesville, GA 30501-3715

Mailing address

1459 Bellemeade Farms Rd SW
Marietta, GA 30008-3857
Phone (678) 815-3158

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20260511002138 GA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 4486122199

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

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

{
    "created_epoch": "1775433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775433600000",
    "number": "1508707183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1459 BELLEMEADE FARMS RD SW",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300083857",
            "telephone_number": "678-815-3158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "743 SPRING ST NE STE 710",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013715",
            "telephone_number": "770-219-8730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZUMA",
        "first_name": "DAMIAN",
        "middle_name": "ONYEDIKACHI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-04-06",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.