Healthcare Provider Details

I. General information

NPI: 1811922487
Provider Name (Legal Business Name): UGOCHI K OHUABUNWA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

1492 GREAT SHOALS DR
LAWRENCEVILLE GA
30045-7088
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-7717
  • Fax:
Mailing address:
  • Phone: 678-407-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number055776
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: