Provider Demographics
NPI:1073788444
Name:NWANERI, MICHAEL OSITA (MBBS, MD, MSC, MBA)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:OSITA
Last Name:NWANERI
Suffix:
Gender:M
Credentials:MBBS, MD, MSC, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1305 HEMBREE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-3810
Mailing Address - Country:US
Mailing Address - Phone:470-485-6342
Mailing Address - Fax:888-723-2802
Practice Address - Street 1:1305 HEMBREE RD STE 203
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-3810
Practice Address - Country:US
Practice Address - Phone:470-485-6342
Practice Address - Fax:888-723-2802
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54852208000000X
GA072609208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1073788444Medicaid
MN370004649Medicare PIN