Provider Demographics
NPI:1427268960
Name:EKWUNIFE, DAVID UMEADI (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:UMEADI
Last Name:EKWUNIFE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3553 BRIDGE WALK DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044
Mailing Address - Country:US
Mailing Address - Phone:770-921-0290
Mailing Address - Fax:770-921-0290
Practice Address - Street 1:BALDWIN STATE PRISON
Practice Address - Street 2:128 LAYING FARM RD
Practice Address - City:HARDWICK
Practice Address - State:GA
Practice Address - Zip Code:31034
Practice Address - Country:US
Practice Address - Phone:478-445-4984
Practice Address - Fax:478-445-2660
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042239174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist