Provider Demographics
NPI:1346017977
Name:EZIUKWU, AKUDO
Entity type:Individual
Prefix:
First Name:AKUDO
Middle Name:
Last Name:EZIUKWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BAYONNE DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3875
Mailing Address - Country:US
Mailing Address - Phone:615-932-0818
Mailing Address - Fax:
Practice Address - Street 1:500 BAYONNE DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3875
Practice Address - Country:US
Practice Address - Phone:615-932-0818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care