Provider Demographics
NPI:1306136551
Name:ILOABUCHI, UJUKA A (MD)
Entity type:Individual
Prefix:
First Name:UJUKA
Middle Name:A
Last Name:ILOABUCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:UJUKA
Other - Middle Name:A
Other - Last Name:OBI-EYISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 TREE LN
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6782
Mailing Address - Country:US
Mailing Address - Phone:770-972-0030
Mailing Address - Fax:770-985-2683
Practice Address - Street 1:1700 TREE LN
Practice Address - Street 2:SUITE 290
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6782
Practice Address - Country:US
Practice Address - Phone:770-972-0330
Practice Address - Fax:770-985-2683
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA73911207VX0000X, 207VG0400X, 282NW0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NW0100XHospitalsGeneral Acute Care HospitalWomen
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology