Provider Demographics
NPI:1942707559
Name:CHUKWUMA, CHIDINMA EVELYN (DO)
Entity Type:Individual
Prefix:DR
First Name:CHIDINMA
Middle Name:EVELYN
Last Name:CHUKWUMA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 HOLCOMB BRIDGE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-5415
Mailing Address - Country:US
Mailing Address - Phone:770-650-8980
Mailing Address - Fax:
Practice Address - Street 1:2570 HOLCOMB BRIDGE RD STE 110
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-5415
Practice Address - Country:US
Practice Address - Phone:770-650-8980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA89650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program