Healthcare Provider Details

I. General information

NPI: 1699721605
Provider Name (Legal Business Name): IGWEBUIKE ONYEKABA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 MEMORIAL DR
DECATUR GA
30032-2706
US

IV. Provider business mailing address

PO BOX 957598
DULUTH GA
30095-9527
US

V. Phone/Fax

Practice location:
  • Phone: 470-355-2340
  • Fax: 470-355-2347
Mailing address:
  • Phone: 470-355-2340
  • Fax: 470-355-2347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number039650
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number039650
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number039650
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: