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General NPI Number Information
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NPI Number | 1295813699
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Entity Type | Individual
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Provider Name | NONYELU A CHUKWUOGO M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 631 RB WILSON DR STE 2
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City | HUNTINGDON
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State | TN
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Zip | 38344-1727
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Country | US
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Telephone | 731-358-4287
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Fax | 731-393-0098
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Provider Business Mailing Address
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Address Line | 631 RB WILSON DR STE 2
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City | HUNTINGDON
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State | TN
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Zip | 38344-1727
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Country | US
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Telephone | 731-358-4287
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Fax | 731-393-0098
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD45034
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License Number State | TN
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