Healthcare Provider Details

I. General information

NPI: 1437491123
Provider Name (Legal Business Name): GABRIEL IKEMBA MADU M.D., D.O., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 ATLANTA HWY # B
ATHENS GA
30606-0812
US

IV. Provider business mailing address

4017 ATLANTA HWY # B
ATHENS GA
30606-0812
US

V. Phone/Fax

Practice location:
  • Phone: 706-850-0067
  • Fax: 706-521-8187
Mailing address:
  • Phone: 706-850-0067
  • Fax: 706-521-8187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25560
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number85427
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: