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General NPI Number Information
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NPI Number | 1366837239
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Entity Type | Individual
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Provider Name | KENECHUKWU NWAGBARA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 162 BMH PHYSICIANS OFFICE BLDG
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City | MARYVILLE
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State | TN
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Zip | 37804-5902
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Country | US
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Telephone | 865-238-6161
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Fax |
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2018023739
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 036177610
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 74653
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License Number State | TN
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