Healthcare Provider Details

I. General information

NPI: 1861809717
Provider Name (Legal Business Name): NNAMDI UHEGWU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2014
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 CLINIC AVE STE 301
CARROLLTON GA
30117-4454
US

IV. Provider business mailing address

157 CLINIC AVE STE 301
CARROLLTON GA
30117-4454
US

V. Phone/Fax

Practice location:
  • Phone: 770-812-6705
  • Fax: 770-812-3371
Mailing address:
  • Phone: 770-812-3631
  • Fax: 770-812-3371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number111226
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: