Provider Demographics
NPI:1033403787
Name:IBEZUE, IJEOMA (MD)
Entity Type:Individual
Prefix:
First Name:IJEOMA
Middle Name:
Last Name:IBEZUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IJEOMA
Other - Middle Name:
Other - Last Name:IBEZUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:550 PEACHTREE ST NE STE 1470
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2242
Mailing Address - Country:US
Mailing Address - Phone:404-589-2670
Mailing Address - Fax:404-589-2671
Practice Address - Street 1:550 PEACHTREE ST NE STE 1470
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2242
Practice Address - Country:US
Practice Address - Phone:404-589-2670
Practice Address - Fax:404-589-2671
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-29
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA75079207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology