MEDICARE: DR. ENI NWABUEZE 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	207R00000X	Internal Medicine Physician	042377	GA

General Provider Information

NPI Number	:	1528122496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENI NWABUEZE M.D

Provider Business Mailing Address
First Line	:	234 PEBBLEBROOK LN
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31220-8714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5566 THOMASTON RD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31220-8118
Country	:	US
Telephone Number	:	478-476-8868
Fax Number	:

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	05/11/2025

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