Healthcare Provider Details

I. General information

NPI: 1154366375
Provider Name (Legal Business Name): UREH NNENNA LEKWAUWA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 10/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 OLD LEXINGTON RD
THOMASVILLE NC
27360-3428
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-475-8121
  • Fax: 336-475-5377
Mailing address:
  • Phone: 336-475-8121
  • Fax: 336-475-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number38530
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: