Provider Demographics
NPI:1497432538
Name:PHUNGWAYO, SIKHONGI SOLOMON (MD)
Entity Type:Individual
Prefix:
First Name:SIKHONGI
Middle Name:SOLOMON
Last Name:PHUNGWAYO
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 1:922 AVOCADO ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-3319
Mailing Address - Country:US
Mailing Address - Phone:512-647-9550
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE HB3014
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0001
Practice Address - Country:US
Practice Address - Phone:512-647-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA15483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine