Provider Demographics
NPI:1073074506
Name:ANYANWU, KELECHUKWU C (DO)
Entity Type:Individual
Prefix:
First Name:KELECHUKWU
Middle Name:C
Last Name:ANYANWU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KELECHUKWU
Other - Middle Name:C
Other - Last Name:ONYEDIMMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:720 WESTVIEW DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1458
Mailing Address - Country:US
Mailing Address - Phone:404-752-1000
Mailing Address - Fax:404-752-1191
Practice Address - Street 1:720 WESTVIEW DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1458
Practice Address - Country:US
Practice Address - Phone:404-752-1000
Practice Address - Fax:404-752-1191
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA92146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA92146OtherGA MEDICAL LICENSE