Provider Demographics
NPI:1942221718
Name:NKWOCHA, DOMINIC EMEKA (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:EMEKA
Last Name:NKWOCHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 766
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-0766
Mailing Address - Country:US
Mailing Address - Phone:678-324-8406
Mailing Address - Fax:678-324-8408
Practice Address - Street 1:4015 S COBB DR SE
Practice Address - Street 2:SUITE 110B
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6303
Practice Address - Country:US
Practice Address - Phone:678-324-8406
Practice Address - Fax:678-324-8408
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA552802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55280OtherLICENSE