Provider Demographics
NPI:1891961066
Name:NWAWKA, CHUKWUDI CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:CHUKWUDI
Middle Name:CHRISTIAN
Last Name:NWAWKA
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 1:3030 MILLWATER XING
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-2999
Mailing Address - Country:US
Mailing Address - Phone:770-826-9394
Mailing Address - Fax:
Practice Address - Street 1:203 MEDICAL WAY STE A
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2517
Practice Address - Country:US
Practice Address - Phone:770-991-0041
Practice Address - Fax:770-538-1663
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040501207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000672185OMedicaid