Provider Demographics
NPI:1568780252
Name:ADIMORA-ONWUKA, DINA
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:ADIMORA-ONWUKA
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:PO BOX 931341
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30003-1341
Mailing Address - Country:US
Mailing Address - Phone:713-885-2820
Mailing Address - Fax:
Practice Address - Street 1:5665 PEACHTREE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1764
Practice Address - Country:US
Practice Address - Phone:678-843-7164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01874207R00000X
GA76398208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1568780252Medicaid
SCNC2237Medicaid
NC1568780252Medicaid
NCNCK711C260Medicare PIN
NCNCK711DMedicare PIN
NCNCK711FMedicare PIN
NCNCK711GMedicare PIN
NCNCK711BMedicare PIN
NCNCK711AMedicare PIN
NCNCK711CMedicare PIN