Healthcare Provider Details

I. General information

NPI: 1497727325
Provider Name (Legal Business Name): ANOZIE A UKAONU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2006
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 US HIGHWAY 19 S
CAMILLA GA
31730-6396
US

IV. Provider business mailing address

PO BOX 2548
ALBANY GA
31702-2548
US

V. Phone/Fax

Practice location:
  • Phone: 229-336-5208
  • Fax: 229-336-2091
Mailing address:
  • Phone: 229-312-5800
  • Fax: 229-312-5853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number053729
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: