Provider Demographics
NPI:1740418557
Name:ANYANWU, IJEOMA CECILIA (MD)
Entity Type:Individual
Prefix:
First Name:IJEOMA
Middle Name:CECILIA
Last Name:ANYANWU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 HOLCOMB BRIDGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4877
Mailing Address - Country:US
Mailing Address - Phone:770-263-9101
Mailing Address - Fax:770-263-9102
Practice Address - Street 1:3780 HOLCOMB BRIDGE RD STE C
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-4877
Practice Address - Country:US
Practice Address - Phone:770-263-9101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD446439208000000X
NY274604208000000X
GA81221208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003212061BMedicaid
NY04078011Medicaid