Provider Demographics
NPI:1326423112
Name:UWAGERIKPE, FELICITAS NNENNA
Entity Type:Individual
Prefix:
First Name:FELICITAS
Middle Name:NNENNA
Last Name:UWAGERIKPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 BOURNEMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7521
Mailing Address - Country:US
Mailing Address - Phone:678-507-9677
Mailing Address - Fax:
Practice Address - Street 1:4995 FLAT SHOALS PKWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5210
Practice Address - Country:US
Practice Address - Phone:404-446-3508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN208165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily