Provider Demographics
NPI:1093921090
Name:NWOKOLO, CHIBUZO E (MD)
Entity Type:Individual
Prefix:
First Name:CHIBUZO
Middle Name:E
Last Name:NWOKOLO
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 1:587 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3938
Mailing Address - Country:US
Mailing Address - Phone:731-421-6510
Mailing Address - Fax:731-421-6500
Practice Address - Street 1:587 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3938
Practice Address - Country:US
Practice Address - Phone:731-421-6510
Practice Address - Fax:731-421-6500
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45077207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514538Medicaid
TNP00727739Medicare PIN
TN3041875Medicare PIN