MEDICARE: DR. CHUMA GODFREY OBINEME M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	90280	SC

General Provider Information

NPI Number	:	1386175552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHUMA GODFREY OBINEME M.D.

Provider Business Mailing Address
First Line	:	1364 CLIFTON RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322
Country	:	US
Telephone Number	:	410-323-4930
Fax Number	:

Provider Business Practice Location Address
First Line	:	5500 FRONT ST STE 260
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29486-8140
Country	:	US
Telephone Number	:	843-376-0670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	06/29/2023

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