Provider Demographics
NPI:1922217926
Name:NELSON-TWAKOR, ONAJEFE S (MD)
Entity Type:Individual
Prefix:
First Name:ONAJEFE
Middle Name:S
Last Name:NELSON-TWAKOR
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:PO BOX 4163
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4163
Mailing Address - Country:US
Mailing Address - Phone:478-741-5945
Mailing Address - Fax:478-743-5890
Practice Address - Street 1:770 PINE ST STE 200
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7513
Practice Address - Country:US
Practice Address - Phone:478-338-9161
Practice Address - Fax:478-259-1541
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD450413207RC0000X, 207RC0001X
GA74935207RC0001X
GA074935207RC0001X
NY225868207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1033537Medicaid
MS02780071Medicaid
GACS1712105106OtherCARESOURCE
LA4N0397061Medicare PIN
LA1033537Medicaid