Healthcare Provider Details

I. General information

NPI: 1861072944
Provider Name (Legal Business Name): PRECIOUS ONYINYECHI OGBONNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 10/22/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WESTVIEW DR SW
ATLANTA GA
30310-1458
US

IV. Provider business mailing address

1800 HOWELL MILL RD NW STE 550
ATLANTA GA
30318-3099
US

V. Phone/Fax

Practice location:
  • Phone: 404-756-1368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number99752
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: