Healthcare Provider Details

I. General information

NPI: 1982312542
Provider Name (Legal Business Name): NNEAMAKA NWUBAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 01/13/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5409 MARYLAND WAY STE 115
BRENTWOOD TN
37027-1076
US

IV. Provider business mailing address

424 CHURCH ST STE 2000
NASHVILLE TN
37219-3304
US

V. Phone/Fax

Practice location:
  • Phone: 615-804-6113
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NNEAMAKA AGOCHUKWU NWUBAH
Title or Position: MD
Credential: MD
Phone: 504-813-9655