Provider Demographics
NPI:1013236686
Name:OBIORA, AUGUSTINE C
Entity Type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:C
Last Name:OBIORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 HIGH PLATEAU DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-5967
Mailing Address - Country:US
Mailing Address - Phone:469-363-8476
Mailing Address - Fax:972-564-3346
Practice Address - Street 1:2709 HIGH PLATEAU DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-5967
Practice Address - Country:US
Practice Address - Phone:469-363-8476
Practice Address - Fax:972-564-3346
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health