Healthcare Provider Details

I. General information

NPI: 1578970513
Provider Name (Legal Business Name): OBIAJULU OGUGUA ANOZIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CENTER ST
COLUMBUS GA
31901-1527
US

IV. Provider business mailing address

710 CENTER ST
COLUMBUS GA
31901-1527
US

V. Phone/Fax

Practice location:
  • Phone: 706-571-1454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number82277
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number82277
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: