Provider Demographics
NPI:1992861603
Name:MBAKWE, OGECHI HELEN (MD)
Entity Type:Individual
Prefix:
First Name:OGECHI
Middle Name:HELEN
Last Name:MBAKWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OGECHI
Other - Middle Name:CHINWE
Other - Last Name:CHUKUKERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6 LESTER RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4786
Mailing Address - Country:US
Mailing Address - Phone:912-681-8999
Mailing Address - Fax:912-681-8989
Practice Address - Street 1:6 LESTER RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4786
Practice Address - Country:US
Practice Address - Phone:912-681-8999
Practice Address - Fax:912-681-8989
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50797-20207R00000X
WAMD60212439207R00000X
GA69221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG8899853Medicare PIN
WAG8899853Medicare PIN