Healthcare Provider Details

I. General information

NPI: 1528550068
Provider Name (Legal Business Name): CHINYERE CHIGBU FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHINYERE NWANGWA

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MILSTEAD RD NE STE 110
CONYERS GA
30012-3849
US

IV. Provider business mailing address

1835 SAVOY DRIVE SUITE 300
ATLANTA GA
30341-1071
US

V. Phone/Fax

Practice location:
  • Phone: 770-760-9949
  • Fax: 770-760-9951
Mailing address:
  • Phone: 770-760-9949
  • Fax: 770-760-9951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN143371
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: