Healthcare Provider Details

I. General information

NPI: 1770987927
Provider Name (Legal Business Name): CHIGOZIE U. OBIAKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 GRANDVIEW PKWY APT 327 CAHABA HEIGHTS
BIRMINGHAM AL
35243-1970
US

IV. Provider business mailing address

3550 GRANDVIEW PKWY APT 327 CAHABA HEIGHTS
BIRMINGHAM AL
35243-1970
US

V. Phone/Fax

Practice location:
  • Phone: 404-630-7309
  • Fax:
Mailing address:
  • Phone: 404-630-7309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD35320
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: