Healthcare Provider Details

I. General information

NPI: 1376118935
Provider Name (Legal Business Name): OMONIGHO SONIA NWOKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 BERMUDA RUN
STATESBORO GA
30458-0858
US

IV. Provider business mailing address

300 W 27TH ST
LUMBERTON NC
28358-3075
US

V. Phone/Fax

Practice location:
  • Phone: 912-764-8396
  • Fax: 912-764-7188
Mailing address:
  • Phone: 910-735-8781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number103985
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: