Healthcare Provider Details

I. General information

NPI: 1841312907
Provider Name (Legal Business Name): UCHENNA PETER KALU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 LAWRENCEVILLE HIGHWAY SUITE 202
DECATUR GA
30033-2526
US

IV. Provider business mailing address

2680 LAWRENCEVILLE HIGHWAY SUITE 202
DECATUR GA
30033-2526
US

V. Phone/Fax

Practice location:
  • Phone: 470-250-1418
  • Fax: 678-487-8644
Mailing address:
  • Phone: 470-250-1418
  • Fax: 678-487-8644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number62127
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number62127
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: