Basic Information
| Provider Information | |||||||||
| NPI: | 1073806527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EJIGIRI | ||||||||
| FirstName: | IJEOMA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 NW 167TH ST STE 1128 | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056286117 | ||||||||
| FaxNumber: | 4047938997 | ||||||||
| Practice Location | |||||||||
| Address1: | 2124 CANDLER RD | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048360272 | ||||||||
| FaxNumber: | 4046660038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2011 | ||||||||
| LastUpdateDate: | 10/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 53033 | CT | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 75054 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.