Efobi, Ellis Ifeanyichukwu

Efobi, Ellis Ifeanyichukwu is an individual health care provider with primary practice located at 1525 E. Park Place Blvd. Suite 300, Stone Mountain GA 30087-3453. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / General Practice is his primary health care specialty. Efobi, Ellis Ifeanyichukwu can be contacted via phone (770) 879-7707.

Contact Information

Primary practice address
1525 E. Park Place Blvd. Suite 300 Stone Mountain GA 30087-3453
Phone: (770) 879-7707
Fax: (770) 879-7708
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 060727 Georgia
Allopathic & Osteopathic Physicians / Pain Medicine 2081P2900X 060727 Georgia

Profile Details

NPI number 1144487018
LBN Legal business name Efobi, Ellis Ifeanyichukwu
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 19th, 2008
Last updated Feb 2nd, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144487018 NPPES
Georgia MEDICAID 594981959A

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