Provider Demographics
NPI:1487846895
Name:ONYILIOGWU, IKEMEFUNE
Entity Type:Individual
Prefix:MR
First Name:IKEMEFUNE
Middle Name:
Last Name:ONYILIOGWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10985 TARA VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-7984
Mailing Address - Country:US
Mailing Address - Phone:678-230-9405
Mailing Address - Fax:404-224-2073
Practice Address - Street 1:10985 TARA VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-7984
Practice Address - Country:US
Practice Address - Phone:678-230-9405
Practice Address - Fax:404-224-2073
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies