Healthcare Provider Details

I. General information

NPI: 1023940830
Provider Name (Legal Business Name): CHIOMA NNEDIMMA NGENE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVE
CHARLESTON SC
29425-0100
US

IV. Provider business mailing address

169 ASHLEY AVE RM 202 MSC 333
CHARLESTON SC
29425-8905
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-7365
  • Fax:
Mailing address:
  • Phone: 843-792-7365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMMD.97073
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: