Provider Demographics
NPI:1295418606
Name:EZENWA, AMARACHUKWU (AUD)
Entity type:Individual
Prefix:
First Name:AMARACHUKWU
Middle Name:
Last Name:EZENWA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1713 MOUNT VERNON RD STE 4
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4243
Mailing Address - Country:US
Mailing Address - Phone:770-394-9499
Mailing Address - Fax:
Practice Address - Street 1:1713 MOUNT VERNON RD STE 4
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4243
Practice Address - Country:US
Practice Address - Phone:770-394-9499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD004380237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter