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NPI Code Detail

MEDICARE: CONSTANCE CHUKWUKA RD

MEDICARE: CONSTANCE CHUKWUKA RD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianLD005717GA
2133V00000XRegistered Dietitian974378NJ

General Provider Information

NPI Number : 1033363718
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONSTANCE CHUKWUKA RD
Provider Business Mailing Address
First Line : 4057 MEDLOCK WOODS DR
Second Line :
City : SNELLVILLE
State : GA
Zip : 30039-2722
Country : US
Telephone Number : 973-444-8181
Fax Number : 908-998-2054
Provider Business Practice Location Address
First Line : 1350 SCENIC HWY N, SUITE 266, RM 203
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-7924
Country : US
Telephone Number : 973-444-8181
Fax Number : 908-998-2054
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2008
Last Update Date : 05/26/2021

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Directions to “ CONSTANCE CHUKWUKA RD” Practice Location

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