Provider Demographics
NPI:1295813699
Name:CHUKWUOGO, NONYELU A (MD)
Entity Type:Individual
Prefix:
First Name:NONYELU
Middle Name:A
Last Name:CHUKWUOGO
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 1:631 RB WILSON DR STE 2
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:TN
Mailing Address - Zip Code:38344-1727
Mailing Address - Country:US
Mailing Address - Phone:731-358-4287
Mailing Address - Fax:731-393-0098
Practice Address - Street 1:631 RB WILSON DR STE 2
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344-1727
Practice Address - Country:US
Practice Address - Phone:731-358-4287
Practice Address - Fax:731-393-0098
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD45034208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ048223Medicaid
TN1516071Medicaid
TN3380640OtherGROUP MEDICARE
TN1516071Medicaid
TN3380640OtherGROUP MEDICAID