Provider Demographics
NPI:1265545891
Name:AMECHI OBIGWE, ADANNA JULIET (MD)
Entity type:Individual
Prefix:
First Name:ADANNA
Middle Name:JULIET
Last Name:AMECHI OBIGWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ADANNA
Other - Middle Name:JULIET
Other - Last Name:AKOGU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1015 HILLCREST DR STE A
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-3165
Mailing Address - Country:US
Mailing Address - Phone:940-552-2530
Mailing Address - Fax:940-552-2539
Practice Address - Street 1:1015 HILLCREST DR STE A
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-3165
Practice Address - Country:US
Practice Address - Phone:940-552-2530
Practice Address - Fax:940-552-2539
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48557207Q00000X
TXP2944207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNI59661Medicare UPIN