Provider Demographics
NPI:1427302215
Name:NDUKWE, UZOMA (DO)
Entity type:Individual
Prefix:DR
First Name:UZOMA
Middle Name:
Last Name:NDUKWE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:UZOMA
Other - Middle Name:
Other - Last Name:EFOBI-NDUKWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-0005
Mailing Address - Country:US
Mailing Address - Phone:770-305-6911
Mailing Address - Fax:770-302-0482
Practice Address - Street 1:115 GRAYSON INDUSTRIAL PKWY STE 12
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-4139
Practice Address - Country:US
Practice Address - Phone:770-305-6911
Practice Address - Fax:770-302-0482
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013748207Q00000X
CT62329207Q00000X
KY04440207Q00000X
GA68079207Q00000X
TXS3257207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I081037Medicare PIN