Healthcare Provider Details

I. General information

NPI: 1750347183
Provider Name (Legal Business Name): JOHN I NWOGU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LEIGHTON AVE STE 702
ANNISTON AL
36207-5765
US

IV. Provider business mailing address

PO BOX 1380
ANNISTON AL
36202-1380
US

V. Phone/Fax

Practice location:
  • Phone: 256-231-2577
  • Fax: 256-231-2576
Mailing address:
  • Phone: 256-235-5860
  • Fax: 256-235-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25365
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: