Healthcare Provider Details

I. General information

NPI: 1750324026
Provider Name (Legal Business Name): UGO ALEXIS IREH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N CUTHBERT ST
COLQUITT GA
39837-3518
US

IV. Provider business mailing address

209 N CUTHBERT ST
COLQUITT GA
39837-3518
US

V. Phone/Fax

Practice location:
  • Phone: 229-758-3385
  • Fax: 229-758-5198
Mailing address:
  • Phone: 229-758-3385
  • Fax: 229-758-5198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number55851
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: