Provider Demographics
NPI:1578623856
Name:EJIEKE, NONYELUM ERINMA (MD)
Entity Type:Individual
Prefix:
First Name:NONYELUM
Middle Name:ERINMA
Last Name:EJIEKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NONYELUM
Other - Middle Name:ERINMA
Other - Last Name:OKORIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:150 GENTILLY BLVD
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8522
Practice Address - Country:US
Practice Address - Phone:770-387-9831
Practice Address - Fax:770-387-9538
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053481207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA478545929BMedicaid
GA66BBBHLMedicare ID - Type Unspecified
GA478545929BMedicaid