Provider Demographics
NPI:1265758502
Name:ODIETE, OGHENERUKEVWE (MD)
Entity type:Individual
Prefix:DR
First Name:OGHENERUKEVWE
Middle Name:
Last Name:ODIETE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1100 LAKE HEARN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1573
Mailing Address - Country:US
Mailing Address - Phone:770-400-9588
Mailing Address - Fax:470-400-3452
Practice Address - Street 1:1825 HIGHWAY 34 E STE 3400
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-6433
Practice Address - Country:US
Practice Address - Phone:770-400-9588
Practice Address - Fax:470-400-3452
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA78089207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology