Provider Demographics
NPI:1659376051
Name:UZOMBA, GODWIN OBINNA (MD)
Entity Type:Individual
Prefix:DR
First Name:GODWIN
Middle Name:OBINNA
Last Name:UZOMBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4456 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-5702
Mailing Address - Country:US
Mailing Address - Phone:980-299-0023
Mailing Address - Fax:
Practice Address - Street 1:4456 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5702
Practice Address - Country:US
Practice Address - Phone:980-299-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2019-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000152207RE0101X
SC23415207RE0101X
TNMD0000032026173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TRICAREOther582305218-GROUP #
NC014KKOtherBCBS NC-GROUP #
AETNAOther7715252-PPO
UNITED HEALTHCAREOther2279397-INDIVIDUAL
AETNAOther3072946-HMO
SCGP3653Medicaid
MAMSIOther2104818
NC1277FOtherBCBS NC-INDIVIDUAL #
NC891277FMedicaid
MEDCOSTOtherC6405
NC582305218OtherBCBS SC - PINEVILLE
SC582305218001OtherBCBS SC-ROCK HILL
SC582305218002OtherBCBS SC - LANCASTER
NC891277FMedicaid
SCGP3653Medicaid
UNITED HEALTHCAREOther2279397-INDIVIDUAL