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General NPI Number Information
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NPI Number | 1124693502
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Entity Type | Individual
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Provider Name | ALEXIS ANN VIOLETTE OGBONNA MD
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Gender | Female
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 96 JONATHAN LUCAS ST STE 210 MSC 323
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City | CHARLESTON
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State | SC
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Zip | 29425-8900
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Country | US
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Telephone | 859-608-4375
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Fax |
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Provider Business Mailing Address
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Address Line | 96 JONATHAN LUCAS ST STE 210 MSC 323
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City | CHARLESTON
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State | SC
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Zip | 29425-8900
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Country | US
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Telephone | 859-608-4375
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Fax |
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | 86121
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 86121
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License Number State | SC
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