Provider Demographics
NPI:1578017703
Name:EZE, JULIA (NP-C)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:EZE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RENAISSANCE PKWY NE APT 2205
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2344
Mailing Address - Country:US
Mailing Address - Phone:205-276-5409
Mailing Address - Fax:
Practice Address - Street 1:4500 HUGH HOWELL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4723
Practice Address - Country:US
Practice Address - Phone:770-807-0841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN217336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily