Provider Demographics
NPI:1932177102
Name:UBANI-EBERE, PATRICIA CHINWENWA (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:CHINWENWA
Last Name:UBANI-EBERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:CHINWENWA
Other - Last Name:UBANI-EBERE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5995 SPRING STREET
Mailing Address - Street 2:PO BOX 324
Mailing Address - City:WARM SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:31830-0324
Mailing Address - Country:US
Mailing Address - Phone:706-672-0208
Mailing Address - Fax:706-672-1593
Practice Address - Street 1:7007 WILLIAMS STREET
Practice Address - Street 2:SUITE C BOX 120
Practice Address - City:GREENVILLE
Practice Address - State:GA
Practice Address - Zip Code:30222
Practice Address - Country:US
Practice Address - Phone:706-672-4818
Practice Address - Fax:706-672-1593
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042618208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000719947ACMedicaid
GA000719947AGMedicaid
GA000719947AGMedicaid
GAF87217Medicare UPIN