Provider Demographics
NPI:1942705512
Name:OGOH, CHIDINMA EKE (NP)
Entity Type:Individual
Prefix:
First Name:CHIDINMA
Middle Name:EKE
Last Name:OGOH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHIDINMA
Other - Middle Name:EKE
Other - Last Name:EGBICHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:421 ASHVILLE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1684
Mailing Address - Country:US
Mailing Address - Phone:478-719-8032
Mailing Address - Fax:
Practice Address - Street 1:639 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6886
Practice Address - Country:US
Practice Address - Phone:478-745-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN221459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily