Basic Information
| Provider Information | |||||||||
| NPI: | 1750347183 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NWOGU | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1380 | ||||||||
| Address2: | |||||||||
| City: | ANNISTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362021380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562355860 | ||||||||
| FaxNumber: | 2562355190 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 LEIGHTON AVE STE 702 | ||||||||
| Address2: | |||||||||
| City: | ANNISTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362075765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2562312577 | ||||||||
| FaxNumber: | 2562312576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 09/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 25365 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 263125 | 05 | AL | MEDICAID | 51519304 | 01 | AL | BLUE CROSS BLUE SHIELD OF ALABAMA / OXFORD OFFICE | OTHER | 51013275 | 01 | AL | BLUE CROSS BLUE SHIELD OF ALABAMA / STRINGFELLOW HOSP | OTHER | 512-54187 | 01 | AL | BLUE CROSS | OTHER | 51013248 | 01 | AL | BLUE CROSS BLUE SHIELD OF ALABAMA / NEARMC HOSP | OTHER | 51517324 | 01 | AL | BLUE CROSS BLUE SHIELD OF ALABAMA / ANNISTON OFFICE | OTHER |