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General NPI Number Information
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NPI Number | 1972232759
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Entity Type | Individual
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Provider Name | BRIAN IKECHUKWU UZOMBA MD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2022
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 925 BRANCH CT STE 201
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City | GROVETOWN
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State | GA
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Zip | 30813-3325
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Country | US
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Telephone | 706-396-3570
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Fax |
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Provider Business Mailing Address
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Address Line | 2324 FIELDCREST RD
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City | AUGUSTA
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State | GA
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Zip | 30906-9465
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Country | US
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Telephone | 404-445-9346
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 13846
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License Number State | GA
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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 | 102756
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License Number State | GA
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