Provider Demographics
NPI:1518914050
Name:NWANKWO, UKPONG ETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:UKPONG
Middle Name:ETTE
Last Name:NWANKWO
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 1:121 MAYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-3018
Mailing Address - Country:US
Mailing Address - Phone:615-459-4686
Mailing Address - Fax:615-459-4086
Practice Address - Street 1:121 MAYFIELD DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3018
Practice Address - Country:US
Practice Address - Phone:615-459-4686
Practice Address - Fax:615-459-4086
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31321207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3842966Medicaid
TN3842966Medicare ID - Type Unspecified
TN3842966Medicaid