Provider Demographics
NPI:1710918933
Name:CHUKWUEKE, PRISCILLA NGOZI (MD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:NGOZI
Last Name:CHUKWUEKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:250 CORPORATE CENTER CT
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6388
Mailing Address - Country:US
Mailing Address - Phone:678-619-0280
Mailing Address - Fax:678-782-6622
Practice Address - Street 1:250 CORPORATE CENTER CT
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6388
Practice Address - Country:US
Practice Address - Phone:678-619-0280
Practice Address - Fax:678-782-6622
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA821372084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program