Provider Demographics
NPI:1033645734
Name:NSOFOR, ECHEZONA GERALD (MD)
Entity Type:Individual
Prefix:MR
First Name:ECHEZONA
Middle Name:GERALD
Last Name:NSOFOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4053 WORTHAM WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-6251
Mailing Address - Country:US
Mailing Address - Phone:207-317-7704
Mailing Address - Fax:662-222-5277
Practice Address - Street 1:14 RICHLAND MEDICAL PARK DR STE 320
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6896
Practice Address - Country:US
Practice Address - Phone:803-434-6771
Practice Address - Fax:803-434-3995
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2023-08-16
Deactivation Date:2017-12-06
Deactivation Code:
Reactivation Date:2018-06-04
Provider Licenses
StateLicense IDTaxonomies
SC83514207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine