Provider Demographics
NPI:1639186240
Name:EJEH, SYLVESTER UNCHENNA (MD)
Entity Type:Individual
Prefix:DR
First Name:SYLVESTER
Middle Name:UNCHENNA
Last Name:EJEH
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 1:3505 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4553
Mailing Address - Country:US
Mailing Address - Phone:910-323-0065
Mailing Address - Fax:910-323-0071
Practice Address - Street 1:3505 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4553
Practice Address - Country:US
Practice Address - Phone:910-323-0065
Practice Address - Fax:910-323-0071
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056823174400000X
TNMD0000038125174400000X
AL00024686174400000X
NC2006-01668207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA817572582AMedicaid
GA817572582AMedicaid
GA06BDJDNMedicare ID - Type Unspecified