Provider Demographics
NPI:1912544784
Name:MALOZERA PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:MALOZERA PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:C
Authorized Official - Last Name:IBEZI-ENENDU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:404-702-9466
Mailing Address - Street 1:P O BOX 8203
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-8203
Mailing Address - Country:US
Mailing Address - Phone:478-783-3610
Mailing Address - Fax:478-783-3611
Practice Address - Street 1:2809 PINE ST
Practice Address - Street 2:
Practice Address - City:UNADILLA
Practice Address - State:GA
Practice Address - Zip Code:31091-7701
Practice Address - Country:US
Practice Address - Phone:478-355-3000
Practice Address - Fax:478-355-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-29
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty