Provider Demographics
NPI:1083745046
Name:OHAGWU, CHRISTAIN C (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTAIN
Middle Name:C
Last Name:OHAGWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 OLD NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3212
Mailing Address - Country:US
Mailing Address - Phone:770-997-1565
Mailing Address - Fax:770-997-1568
Practice Address - Street 1:5820 OLD NATIONAL HIGHWAY
Practice Address - Street 2:STE 250
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3212
Practice Address - Country:US
Practice Address - Phone:770-997-1565
Practice Address - Fax:770-997-1568
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039888207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52624568002OtherBLUE CROSS BLUE SHIELD
GA00685033JMedicaid
GA10033956OtherAMERIGROUP
11BDMWSMedicare PIN