Basic Information
| Provider Information | |||||||||
| NPI: | 1598253908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NWAGBARA | ||||||||
| FirstName: | CHINONYELUM | ||||||||
| MiddleName: | DORIS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ELUI | ||||||||
| OtherFirstName: | CHINONYELUM | ||||||||
| OtherMiddleName: | DORIS | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | MOREHOUSE SCHOOL OF MEDICINE/GME 720 WESTVIEW DRIVE, SW | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047561383 | ||||||||
| FaxNumber: | 4047561313 | ||||||||
| Practice Location | |||||||||
| Address1: | MOREHOUSE SCHOOL OF MEDICINE | ||||||||
| Address2: | GME 720 WESTVIEW DRIVE SW | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047561383 | ||||||||
| FaxNumber: | 4047561313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2018 | ||||||||
| LastUpdateDate: | 05/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.