Basic Information
Provider Information | |||||||||
NPI: | 1396489720 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ONYEKWERE | ||||||||
FirstName: | ADAKU | ||||||||
MiddleName: | CECILIA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ONYEKWERE | ||||||||
OtherFirstName: | ADAKU | ||||||||
OtherMiddleName: | CECILA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 208 SUNDOWN DR | ||||||||
Address2: |   | ||||||||
City: | ANTIOCH | ||||||||
State: | TN | ||||||||
PostalCode: | 370134679 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6155788026 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1005 DR DB TODD JR BLVD | ||||||||
Address2: |   | ||||||||
City: | NASHVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 372083501 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6153276168 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/22/2022 | ||||||||
LastUpdateDate: | 04/22/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/21/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X |   |   | N | 193400000X SINGLE SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 390200000X |   | TN | Y |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   |
No ID Information.