MEDICARE: OVIE E UGHWANOGHO MD

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	207R00000X	Internal Medicine Physician	055311	GA

General Provider Information

NPI Number	:	1407860323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OVIE E UGHWANOGHO MD

Provider Business Mailing Address
First Line	:	1413 CLEVELAND AVENUE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-3417
Country	:	US
Telephone Number	:	404-768-2669
Fax Number	:	404-768-3479

Provider Business Practice Location Address
First Line	:	1413 CLEVELAND AVENUE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-3417
Country	:	US
Telephone Number	:	404-768-2669
Fax Number	:	404-768-3479

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	11/05/2007

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