Provider Demographics
NPI:1639564990
Name:ADEKWEH, OGECHUKWU
Entity Type:Individual
Prefix:
First Name:OGECHUKWU
Middle Name:
Last Name:ADEKWEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 CLEVELAND AVE BLDG 100
Mailing Address - Street 2:300-A
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6947
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1513 CLEVELAND AVE BLDG 100
Practice Address - Street 2:300-A
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6947
Practice Address - Country:US
Practice Address - Phone:404-756-1256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN63535207Q00000X
GA80092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine