MEDICARE: MR. IKE UZODINMA

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	3336M0003X	Managed Care Organization Pharmacy	RPH015935	GA

General Provider Information

NPI Number	:	1598617052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IKE UZODINMA

Provider Business Mailing Address
First Line	:	920 DANNON VW SW STE 3204
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2161
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 DANNON VW SW STE 3204
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2161
Country	:	US
Telephone Number	:	404-210-5109
Fax Number	:

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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Directions to “ MR. IKE UZODINMA ” Practice Location

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