Basic Information
| Provider Information | |||||||||
| NPI: | 1306136551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ILOABUCHI | ||||||||
| FirstName: | UJUKA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OBI-EYISI | ||||||||
| OtherFirstName: | UJUKA | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1700 TREE LN | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300786782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709720030 | ||||||||
| FaxNumber: | 7709852683 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 TREE LN | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300786782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709720330 | ||||||||
| FaxNumber: | 7709852683 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2011 | ||||||||
| LastUpdateDate: | 07/01/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | 73911 | GA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 207VG0400X | 73911 | GA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | 282NW0100X | 73911 | GA | Y | Hospitals | General Acute Care Hospital | Women |
No ID Information.