Healthcare Provider Details

I. General information

NPI: 1740468016
Provider Name (Legal Business Name): METRO INFECTIOUS DISEASE ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1413 CLEVELAND AVE
EAST POINT GA
30344-6901
US

IV. Provider business mailing address

1413 CLEVELAND AVE
EAST POINT GA
30344-6901
US

V. Phone/Fax

Practice location:
  • Phone: 404-768-2669
  • Fax: 404-768-3479
Mailing address:
  • Phone: 404-768-2669
  • Fax: 404-768-3479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. OVIE E UGHWANOGHO
Title or Position: OWNER
Credential: MD
Phone: 404-768-2669