Provider Demographics
NPI:1841819182
Name:GREENVILLE RHEUMATOLOGY & ALLERGY
Entity type:Organization
Organization Name:GREENVILLE RHEUMATOLOGY & ALLERGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RHEUMATOLOGIST & ALLERGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EZINMA
Authorized Official - Middle Name:
Authorized Official - Last Name:EZEALAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:864-336-2323
Mailing Address - Street 1:2104A WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5941
Mailing Address - Country:US
Mailing Address - Phone:864-336-2323
Mailing Address - Fax:864-336-2323
Practice Address - Street 1:2104A WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5941
Practice Address - Country:US
Practice Address - Phone:864-336-2323
Practice Address - Fax:864-336-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-15
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty