MEDICARE: PETER CHINEDU NWAIZUZU 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	4301084854	MI

General Provider Information

NPI Number	:	1134202674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER CHINEDU NWAIZUZU M.D

Provider Business Mailing Address
First Line	:	750 MILTON DR
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30252-2897
Country	:	US
Telephone Number	:	770-865-2619
Fax Number	:

Provider Business Practice Location Address
First Line	:	3750 N HENRY BLVD
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-3936
Country	:	US
Telephone Number	:	678-379-7190
Fax Number	:	202-207-3732

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	06/21/2024

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