Provider Demographics
NPI:1851133219
Name:UWUMIRO, FIDELIS ESOSA (MD)
Entity type:Individual
Prefix:MR
First Name:FIDELIS
Middle Name:ESOSA
Last Name:UWUMIRO
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:SOUTHERN REGIONAL MEDICAL CENTER
Mailing Address - Street 2:11 UPPER RIVERDALE RD
Mailing Address - City:RIVERDAL
Mailing Address - State:GA
Mailing Address - Zip Code:30274
Mailing Address - Country:US
Mailing Address - Phone:770-991-8026
Mailing Address - Fax:
Practice Address - Street 1:SOUTHERN REGIONAL MEDICAL CENTER
Practice Address - Street 2:11 UPPER RIVERDALE RD.
Practice Address - City:RIVERDAL
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:770-991-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program