Healthcare Provider Details

I. General information

NPI: 1427672633
Provider Name (Legal Business Name): CHINOMNSO EKEKE ONYEKABA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8820 HOSPITAL DR
DOUGLASVILLE GA
30134-2266
US

IV. Provider business mailing address

8820 HOSPITAL DR
DOUGLASVILLE GA
30134-2266
US

V. Phone/Fax

Practice location:
  • Phone: 770-947-3000
  • Fax: 770-947-3012
Mailing address:
  • Phone: 770-947-3000
  • Fax: 770-947-3012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL84151
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number96106
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: