Provider Demographics
NPI:1497485668
Name:EZUMA, GABRIEL OKWUCHIGEMEZU JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:OKWUCHIGEMEZU
Last Name:EZUMA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1459 BELLEMEADE FARMS RD SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-3857
Mailing Address - Country:US
Mailing Address - Phone:404-645-5802
Mailing Address - Fax:
Practice Address - Street 1:1446 HARPER ST AUGUSTA GA 30912
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0001
Practice Address - Country:US
Practice Address - Phone:706-721-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13801208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics