Provider Demographics
NPI:1902442981
Name:NWIZU, ONUZULIKE
Entity type:Individual
Prefix:
First Name:ONUZULIKE
Middle Name:
Last Name:NWIZU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 CHAMBLEE TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-4501
Mailing Address - Country:US
Mailing Address - Phone:770-493-1922
Mailing Address - Fax:770-493-1922
Practice Address - Street 1:4255 CHAMBLEE TUCKER RD
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-4501
Practice Address - Country:US
Practice Address - Phone:770-493-1922
Practice Address - Fax:770-493-1922
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA-10059-M101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)