Provider Demographics
NPI:1407860323
Name:UGHWANOGHO, OVIE E (MD)
Entity Type:Individual
Prefix:
First Name:OVIE
Middle Name:E
Last Name:UGHWANOGHO
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 1:1413 CLEVELAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3417
Mailing Address - Country:US
Mailing Address - Phone:404-768-2669
Mailing Address - Fax:404-768-3479
Practice Address - Street 1:1413 CLEVELAND AVENUE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30344-3417
Practice Address - Country:US
Practice Address - Phone:404-768-2669
Practice Address - Fax:404-768-3479
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11SCDHJMedicare PIN
GAI17775Medicare UPIN