Provider Demographics
NPI:1033157144
Name:EKELEDO, BROWN NNAMDI (MD)
Entity Type:Individual
Prefix:DR
First Name:BROWN
Middle Name:NNAMDI
Last Name:EKELEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:770 PINE ST
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2173
Mailing Address - Country:US
Mailing Address - Phone:478-746-2719
Mailing Address - Fax:478-746-4808
Practice Address - Street 1:770 PINE ST
Practice Address - Street 2:SUITE 550
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2173
Practice Address - Country:US
Practice Address - Phone:478-746-2719
Practice Address - Fax:478-746-4808
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025151208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA319775OtherWELLCARE OF GEORGIA NUMBE
GAC01817Medicare UPIN
GA319775OtherWELLCARE OF GEORGIA NUMBE