MEDICARE: DR. OBINWANNE FIDELIS C UGWONALI 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	207X00000X	Orthopaedic Surgery Physician	057508	GA
2	207XS0106X	Orthopaedic Hand Surgery Physician	057508	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	478817	OTHER	MA	TUFTS HEALTH PLAN
2	J29526	OTHER	MA	BCBS MA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669448221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OBINWANNE FIDELIS C UGWONALI MD

Provider Business Mailing Address
First Line	:	5505 PEACHTREE DUNWOODY RD NE
Second Line	:	SUITE 600
City	:	ATLANTA
State	:	GA
Zip	:	30342-1705
Country	:	US
Telephone Number	:	404-355-0743
Fax Number	:	404-425-1071

Provider Business Practice Location Address
First Line	:	5505 PEACHTREE DUNWOODY RD NE
Second Line	:	SUITE 600
City	:	ATLANTA
State	:	GA
Zip	:	30342-1705
Country	:	US
Telephone Number	:	404-355-0743
Fax Number	:	404-425-1071

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	03/02/2026

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Directions to “ DR. OBINWANNE FIDELIS C UGWONALI MD” Practice Location

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