Healthcare Provider Details

I. General information

NPI: 1417445255
Provider Name (Legal Business Name): CHIJIOKE DAVID UKOHA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S PALESTINE ST
ATHENS TX
75751-5610
US

IV. Provider business mailing address

306 STONEMEADE WAY
COPPELL TX
75019-2679
US

V. Phone/Fax

Practice location:
  • Phone: 903-676-1000
  • Fax:
Mailing address:
  • Phone: 214-682-7634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberT2518
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT2518
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: