Healthcare Provider Details

I. General information

NPI: 1609362417
Provider Name (Legal Business Name): NONSO SAMUEL EMECHEBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2018
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3699 CASCADE RD SW STE B2
ATLANTA GA
30331-2163
US

IV. Provider business mailing address

4001 COLISEUM DR STE 300
HAMPTON VA
23666-6257
US

V. Phone/Fax

Practice location:
  • Phone: 404-691-7006
  • Fax:
Mailing address:
  • Phone: 757-827-2025
  • Fax: 757-275-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101271440
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number111017
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: