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General NPI Number Information
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NPI Number | 1194782011
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Entity Type | Individual
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Provider Name | JONATHAN OSITA NWILOH MD
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 07/20/2024
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Provider Practice Location Address
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Address Line | 600 GRESHAM DR STE 8600
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City | NORFOLK
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State | VA
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Zip | 23507-1904
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Country | US
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Telephone | 757-388-6005
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Fax |
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Provider Business Mailing Address
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Address Line | 960 JOHNSON FERRY RD NE SUITE 518
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City | ATLANTA
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State | GA
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Zip | 30342-1631
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Country | US
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Telephone | 678-904-5182
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 036139866
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 037035
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 0101268803
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License Number State | VA
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