Provider Demographics
NPI:1922091990
Name:EJIM, LINUS ONYEMAECHI (MD)
Entity Type:Individual
Prefix:
First Name:LINUS
Middle Name:ONYEMAECHI
Last Name:EJIM
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 1:516 SPARTA ROAD
Mailing Address - Street 2:P.O.BOX 761
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082
Mailing Address - Country:US
Mailing Address - Phone:478-552-1200
Mailing Address - Fax:866-306-4654
Practice Address - Street 1:516 SPARTA RD
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1859
Practice Address - Country:US
Practice Address - Phone:478-552-1200
Practice Address - Fax:478-552-5600
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050617207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00978425AMedicaid
GA00978425AMedicaid
GA11BDVZCMedicare PIN