Provider Demographics
NPI:1154128023
Name:MUOGBO, CHINWE
Entity type:Individual
Prefix:
First Name:CHINWE
Middle Name:
Last Name:MUOGBO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3553 FALLEN OAK DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7745
Mailing Address - Country:US
Mailing Address - Phone:678-656-0179
Mailing Address - Fax:
Practice Address - Street 1:3553 FALLEN OAK DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-7745
Practice Address - Country:US
Practice Address - Phone:678-656-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician