Provider Demographics
NPI:1477746469
Name:ASH-MALACHI, EZRA MOZELLE (MD)
Entity Type:Individual
Prefix:
First Name:EZRA
Middle Name:MOZELLE
Last Name:ASH-MALACHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EZRA
Other - Middle Name:MOZELLE
Other - Last Name:ASH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3788
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29230-3788
Mailing Address - Country:US
Mailing Address - Phone:803-733-5969
Mailing Address - Fax:803-217-0026
Practice Address - Street 1:9023 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:SC
Practice Address - Zip Code:29061-9687
Practice Address - Country:US
Practice Address - Phone:803-978-1848
Practice Address - Fax:803-978-1852
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1883OtherMEDICAID GROUP
SC299698Medicaid
SCGP2626OtherMEDICAID GROUP
SCGP1883OtherMEDICAID GROUP
SCAA52356341Medicare PIN
SCGP2626OtherMEDICAID GROUP
SC299698Medicaid