Healthcare Provider Details

I. General information

NPI: 1104034339
Provider Name (Legal Business Name): CHIMA AUSTIN UKACHI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2007
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 SKYWAY DR STE 807
OPELIKA AL
36801-7141
US

IV. Provider business mailing address

3320 SKYWAY DR STE 807
OPELIKA AL
36801-7141
US

V. Phone/Fax

Practice location:
  • Phone: 334-539-1770
  • Fax:
Mailing address:
  • Phone: 334-539-1770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number26260
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number26260
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number26260
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number26260
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26260
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: