Provider Demographics
NPI:1942520192
Name:OKWUMABUA, ISIOMA CHINWENDU (MD)
Entity Type:Individual
Prefix:DR
First Name:ISIOMA
Middle Name:CHINWENDU
Last Name:OKWUMABUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ISIOMA
Other - Middle Name:CHINWENDU
Other - Last Name:NWOKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:720 WESTVIEW DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1458
Mailing Address - Country:US
Mailing Address - Phone:404-756-1400
Mailing Address - Fax:404-756-1402
Practice Address - Street 1:1513 EAST CLEVELAND AVE
Practice Address - Street 2:BUILDING 500
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6949
Practice Address - Country:US
Practice Address - Phone:404-752-1000
Practice Address - Fax:404-752-1191
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA070256207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003150200AMedicaid