Healthcare Provider Details

I. General information

NPI: 1356211304
Provider Name (Legal Business Name): CHIMDI UKOHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 HWY 40 E
KINGSLAND GA
31548-6731
US

IV. Provider business mailing address

10123 CROFTON CT
JACKSONVILLE FL
32246-1895
US

V. Phone/Fax

Practice location:
  • Phone: 912-673-9130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH035920
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: