Provider Demographics
NPI:1811019730
Name:IWU, VIVIAN CHIZOROM (DPM)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:CHIZOROM
Last Name:IWU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2450 ATLANTA HWY
Mailing Address - Street 2:STE 402
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1254
Mailing Address - Country:US
Mailing Address - Phone:678-947-0973
Mailing Address - Fax:678-947-2836
Practice Address - Street 1:540 POWDER SPRINGS ST STE B6
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3559
Practice Address - Country:US
Practice Address - Phone:770-702-8723
Practice Address - Fax:770-702-8809
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001071213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA924062921AMedicaid
GAP00460780OtherRAILROAD MEDICARE
GAOTH000Medicare UPIN
GAP00460780OtherRAILROAD MEDICARE