Provider Demographics
NPI:1881185387
Name:ODUNVBUN, PRECIOUS OGHENEFEJIRO (MD)
Entity Type:Individual
Prefix:MISS
First Name:PRECIOUS
Middle Name:OGHENEFEJIRO
Last Name:ODUNVBUN
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 1:657 HEMLOCK ST STE 220
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8311
Mailing Address - Country:US
Mailing Address - Phone:478-741-7241
Mailing Address - Fax:478-745-8932
Practice Address - Street 1:657 HEMLOCK ST STE 220
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8311
Practice Address - Country:US
Practice Address - Phone:312-619-0946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA89545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine