Nkemakonam Egolum, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN122975 Issued in GA

Practice address

10700 Medlock Bridge Rd Ste 204
Johns Creek, GA 30097-8455

Phone

(770) 764-0840

Fax

(770) 764-0870

NPI assigned

May 31, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Creekside Oral Surgery Inc

  • Oral and Maxillofacial Surgery (Dentist)
  • Johns Creek, GA
  • NPI 1992586143

  Oral and Maxillofacial Surgery

  NPD Authorized official
• Bowie Oral and Facial Surgery Center Inc.

  • Oral and Maxillofacial Surgery (Dentist)
  • Bowie, MD
  • NPI 1972081313

  Oral and Maxillofacial Surgery

  NPD Authorized official

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697068800000",
    "number": "1992142806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10700 MEDLOCK BRIDGE RD STE 204",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300978455",
            "telephone_number": "770-764-0840",
            "fax_number": "770-764-0870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10700 MEDLOCK BRIDGE RD STE 204",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "300978455",
            "telephone_number": "770-764-0840",
            "fax_number": "770-764-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGOLUM",
        "first_name": "NKEMAKONAM",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-31",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "DN122975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher David Easley, OD
• Natalie Eden
• Pamela Edgerton
• Edgewater Medical LLC
• Christina Louise Ediale
• Ehca Diagnostics, LLC
• Ehca Johns Creek, LLC
• Ehi Pharmacy Solutions, LLC.
• Eli Pharmacy Corporation
• Elian Healthcare Staffing Associates, LLC

• All providers in Johns Creek, GA
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.