Provider Demographics
NPI:1558314252
Name:EMEROLE, OBINNAYA (MD)
Entity type:Individual
Prefix:
First Name:OBINNAYA
Middle Name:
Last Name:EMEROLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6135
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-6135
Mailing Address - Country:US
Mailing Address - Phone:478-738-9443
Mailing Address - Fax:478-738-9750
Practice Address - Street 1:654 1ST ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2851
Practice Address - Country:US
Practice Address - Phone:478-738-9443
Practice Address - Fax:478-738-9750
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041550174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000716493DMedicaid
GA000716493DMedicaid
GAGRP3732Medicare ID - Type Unspecified