Provider Demographics
NPI:1154366375
Name:LEKWAUWA, UREH NNENNA (MD)
Entity type:Individual
Prefix:DR
First Name:UREH
Middle Name:NNENNA
Last Name:LEKWAUWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-475-8121
Mailing Address - Fax:336-475-5377
Practice Address - Street 1:207 OLD LEXINGTON RD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-3428
Practice Address - Country:US
Practice Address - Phone:336-475-8121
Practice Address - Fax:336-475-5377
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC385302084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135JCOtherBLUE CROSS BLUE SHIELD
NC8911131Medicaid
NC2247815Medicare ID - Type Unspecified
NCE67504Medicare UPIN