Provider Demographics
NPI:1699721605
Name:ONYEKABA, IGWEBUIKE (MD)
Entity type:Individual
Prefix:DR
First Name:IGWEBUIKE
Middle Name:
Last Name:ONYEKABA
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 957598
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30095-9527
Mailing Address - Country:US
Mailing Address - Phone:470-355-2340
Mailing Address - Fax:470-355-2347
Practice Address - Street 1:3375 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-2706
Practice Address - Country:US
Practice Address - Phone:470-355-2340
Practice Address - Fax:470-355-2347
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039650207RG0300X, 208D00000X, 207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01045490AOtherINDIANA LICENSE
NY198714OtherNEW YORK LICENSE
IN01045490BOtherCSR
NJ25MA06176700OtherNEW JERSEY LICENSE
BO4312904OtherDEA
NY198714OtherNEW YORK LICENSE
BO4312904OtherDEA