Healthcare Provider Details

I. General information

NPI: 1700634870
Provider Name (Legal Business Name): UGOCHI CHIZUOROM ABAZIE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: UGOCHI CHIZUOROM OKEREKE M.D

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 08/15/2025
Certification Date:
Deactivation Date: 01/13/2025
Reactivation Date: 08/14/2025

III. Provider practice location address

11 UPPER RIVERDALE ROAD SW
RIVERDALE GA
30274
US

IV. Provider business mailing address

11 UPPER RIVERDALE ROAD SW
RIVERDALE GA
30274
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-8026
  • Fax: 773-257-6027
Mailing address:
  • Phone: 770-991-8026
  • Fax: 773-257-6027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125083174
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: