Provider Demographics
NPI:1164836003
Name:EGBUNIWE, OLIVE (RD)
Entity Type:Individual
Prefix:
First Name:OLIVE
Middle Name:
Last Name:EGBUNIWE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 RONALD REAGAN DR STE C
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-7607
Mailing Address - Country:US
Mailing Address - Phone:706-868-0319
Mailing Address - Fax:706-868-3719
Practice Address - Street 1:629 RONALD REAGAN DR STE C
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-7607
Practice Address - Country:US
Practice Address - Phone:706-868-0319
Practice Address - Fax:706-868-3719
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered