Healthcare Provider Details

I. General information

NPI: 1508883414
Provider Name (Legal Business Name): UCHECHI NWABUGO ILOKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 COURT DR SUITE A
GASTONIA NC
28054-3450
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 704-671-6400
  • Fax: 704-671-6449
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number200901096
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: