Healthcare Provider Details

I. General information

NPI: 1114364130
Provider Name (Legal Business Name): CHIMEZIE OBINNA NLEWEM MD/DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 NEWTON RD
ALBANY GA
31701-3424
US

IV. Provider business mailing address

204 N WESTOVER BLVD
ALBANY GA
31707-2983
US

V. Phone/Fax

Practice location:
  • Phone: 229-431-3120
  • Fax: 229-431-3345
Mailing address:
  • Phone: 229-888-6559
  • Fax: 229-436-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116025893
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number078699
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: