Provider Demographics
NPI:1487677340
Name:NNAWUCHI-EKENNA, CHIAZO (MD)
Entity Type:Individual
Prefix:
First Name:CHIAZO
Middle Name:
Last Name:NNAWUCHI-EKENNA
Suffix:
Gender:F
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:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39568-0726
Mailing Address - Country:US
Mailing Address - Phone:228-762-9595
Mailing Address - Fax:228-762-9494
Practice Address - Street 1:4105 HOSPITAL ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5312
Practice Address - Country:US
Practice Address - Phone:228-762-9595
Practice Address - Fax:228-762-9494
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS188512080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000652003Medicaid
MS00652003Medicaid