Healthcare Provider Details

I. General information

NPI: 1942520192
Provider Name (Legal Business Name): ISIOMA CHINWENDU OKWUMABUA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ISIOMA CHINWENDU NWOKO M.B.B.S

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 EAST CLEVELAND AVE BUILDING 500
EAST POINT GA
30344-6949
US

IV. Provider business mailing address

720 WESTVIEW DR SW
ATLANTA GA
30310-1458
US

V. Phone/Fax

Practice location:
  • Phone: 404-752-1000
  • Fax: 404-752-1191
Mailing address:
  • Phone: 404-756-1400
  • Fax: 404-756-1402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number070256
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: