Provider Demographics
NPI:1538640495
Name:LODESTAR OBSTETRICS AND GYNECOLOGY LTD
Entity Type:Organization
Organization Name:LODESTAR OBSTETRICS AND GYNECOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUKWUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAWKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-885-3096
Mailing Address - Street 1:203 MEDICAL WAY STE A
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2517
Mailing Address - Country:US
Mailing Address - Phone:770-991-0041
Mailing Address - Fax:
Practice Address - Street 1:203 MEDICAL WAY STE A
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2517
Practice Address - Country:US
Practice Address - Phone:770-991-0041
Practice Address - Fax:770-538-1663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133758207V00000X
207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1891961066Medicaid
GA000672185OMedicaid