MEDICARE: DR. YVONNE UKWU M.D.

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
1	207Q00000X	Family Medicine Physician	008419	GA

General Provider Information

NPI Number	:	1073963229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YVONNE UKWU M.D.

Provider Business Mailing Address
First Line	:	2727 PACES FERRY RD SE STE 1-1100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-6151
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3699 CASCADE RD SW STE B2
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2163
Country	:	US
Telephone Number	:	404-691-7006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2016
Last Update Date	:	10/22/2019

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