Provider Demographics
NPI:1184607384
Name:OBAMWONYI, ANDREW OSAZE (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:OSAZE
Last Name:OBAMWONYI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3431 SANDWEDGE CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-4778
Mailing Address - Country:US
Mailing Address - Phone:770-736-4928
Mailing Address - Fax:770-736-4928
Practice Address - Street 1:78 TH MEDICAL GROUP
Practice Address - Street 2:655 7TH STREET, BLDG 207
Practice Address - City:ROBINS AIR FORCE BASE
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-327-7588
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0468922083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine