Provider Demographics
NPI:1821151754
Name:EZEOKE, FRANKLIN C
Entity Type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:C
Last Name:EZEOKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 CRUSE RD
Mailing Address - Street 2:STE 1901
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7140
Mailing Address - Country:US
Mailing Address - Phone:770-806-9811
Mailing Address - Fax:770-806-9812
Practice Address - Street 1:2775 CRUSE RD
Practice Address - Street 2:STE 1901
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7140
Practice Address - Country:US
Practice Address - Phone:770-806-9811
Practice Address - Fax:770-806-9812
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2006025710332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies