Provider Demographics
NPI:1164625950
Name:AGUWA, UCHENNA E (DO)
Entity Type:Individual
Prefix:
First Name:UCHENNA
Middle Name:E
Last Name:AGUWA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:UCHE
Other - Middle Name:
Other - Last Name:AGUWA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:2400 MT. ZION PARKWAY
Practice Address - Street 2:KAISER PERMANENTE SOUTHWOOD MEDICAL CENTER
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:770-603-3668
Practice Address - Fax:740-374-1693
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009380207P00000X
GA072443207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV38100017862Medicaid
OH2949117Medicaid
OHP00997170OtherRRMCR
OH4254512Medicare PIN
OH2949117Medicaid