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General NPI Number Information
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NPI Number | 1033363718
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Entity Type | Individual
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Provider Name | CONSTANCE CHUKWUKA RD
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Gender | Female
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Dates
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Enumeration Date | 11/08/2008
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 1350 SCENIC HWY N, SUITE 266, RM 203
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City | SNELLVILLE
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State | GA
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Zip | 30078-7924
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Country | US
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Telephone | 973-444-8181
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Fax | 908-998-2054
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Provider Business Mailing Address
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Address Line | 4057 MEDLOCK WOODS DR
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City | SNELLVILLE
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State | GA
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Zip | 30039-2722
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Country | US
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Telephone | 973-444-8181
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Fax | 908-998-2054
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LD005717
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 974378
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License Number State | NJ
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