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General NPI Number Information
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NPI Number | 1588270391
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Entity Type | Individual
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Provider Name | BUZZY C OGUIKE PA
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Gender | Male
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Dates
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Enumeration Date | 09/17/2020
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 484 IRVIN CT STE 110
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City | DECATUR
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State | GA
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Zip | 30030-5406
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Country | US
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Telephone | 770-962-3642
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Fax | 770-962-3643
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Provider Business Mailing Address
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Address Line | 2041 MESA VALLEY WAY STE 100
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City | AUSTELL
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State | GA
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Zip | 30106-6856
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Country | US
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Telephone | 770-944-1100
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Fax | 770-944-6469
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10029
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License Number State | GA
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