Provider Demographics
NPI:1225509573
Name:UDEZE, IGWEBUIKE MOSES (NP)
Entity Type:Individual
Prefix:
First Name:IGWEBUIKE
Middle Name:MOSES
Last Name:UDEZE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 NEW MACLAND ROAD, SUITE 200 - 193
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2000
Mailing Address - Country:US
Mailing Address - Phone:404-693-5565
Mailing Address - Fax:920-212-2048
Practice Address - Street 1:3721 NEW MACLAND ROAD, SUITE 200 - 193
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2000
Practice Address - Country:US
Practice Address - Phone:404-693-5565
Practice Address - Fax:920-212-2048
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN228894363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care