Healthcare Provider Details

I. General information

NPI: 1184883985
Provider Name (Legal Business Name): OGBONNA CHIGOZIE OGBU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 EAGLES LANDING PKWY
STOCKBRIDGE GA
30281-5085
US

IV. Provider business mailing address

1133 EAGLES LANDING PKWY
STOCKBRIDGE GA
30281-5085
US

V. Phone/Fax

Practice location:
  • Phone: 404-367-3014
  • Fax: 404-367-3558
Mailing address:
  • Phone: 404-367-3014
  • Fax: 404-367-3558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number068084
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number068084
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: