Provider Demographics
NPI:1528550068
Name:CHIGBU, CHINYERE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CHINYERE
Middle Name:
Last Name:CHIGBU
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CHINYERE
Other - Middle Name:
Other - Last Name:NWANGWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1071
Mailing Address - Country:US
Mailing Address - Phone:770-760-9949
Mailing Address - Fax:770-760-9951
Practice Address - Street 1:1501 MILSTEAD RD NE STE 110
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3849
Practice Address - Country:US
Practice Address - Phone:770-760-9949
Practice Address - Fax:770-760-9951
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN143371363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003207291FMedicaid
GAG04558AOtherMEDICARE PTAN
GA003207291GMedicaid