Provider Demographics
NPI:1508459876
Name:NWAGWU, ASSUMPTA UZOMACHI
Entity Type:Individual
Prefix:
First Name:ASSUMPTA
Middle Name:UZOMACHI
Last Name:NWAGWU
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 1:5604 WENDY BAGWELL PKWY
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-7813
Mailing Address - Country:US
Mailing Address - Phone:770-439-3070
Mailing Address - Fax:770-439-3071
Practice Address - Street 1:5604 WENDY BAGWELL PKWY
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-7813
Practice Address - Country:US
Practice Address - Phone:770-439-3070
Practice Address - Fax:770-439-3071
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN138746363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty