Provider Demographics
NPI:1285418475
Name:MORAH, CHIGOZIE JOHN
Entity type:Individual
Prefix:
First Name:CHIGOZIE
Middle Name:JOHN
Last Name:MORAH
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 1:3340 CUMBERLAND BLVD SE APT 523
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3948
Mailing Address - Country:US
Mailing Address - Phone:678-314-8816
Mailing Address - Fax:
Practice Address - Street 1:3340 CUMBERLAND BLVD SE APT 523
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3948
Practice Address - Country:US
Practice Address - Phone:678-314-8816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health