Provider Demographics
NPI:1740389188
Name:EJEH, IJEOMA ACHOLONU (MD)
Entity Type:Individual
Prefix:
First Name:IJEOMA
Middle Name:ACHOLONU
Last Name:EJEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 FERNCREEK DRIVE
Mailing Address - Street 2:SUITE 601
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2569
Mailing Address - Country:US
Mailing Address - Phone:910-485-3880
Mailing Address - Fax:910-485-5341
Practice Address - Street 1:4140 FERNCREEK DRIVE
Practice Address - Street 2:SUITE 601
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2569
Practice Address - Country:US
Practice Address - Phone:910-485-3880
Practice Address - Fax:910-485-5341
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051877174400000X
NC2007-00415208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCI123284Medicare UPIN