Provider Demographics
NPI:1336214931
Name:AGWUNOBI, ANDREW C (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:AGWUNOBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 CROSSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2916
Mailing Address - Country:US
Mailing Address - Phone:770-692-1914
Mailing Address - Fax:770-692-1919
Practice Address - Street 1:526 CROSSTOWN RD
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-2916
Practice Address - Country:US
Practice Address - Phone:770-692-1914
Practice Address - Fax:770-692-1919
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050336208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics