Provider Demographics
NPI:1477086536
Name:OHAEGBULAM, GAIL (MD)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:OHAEGBULAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 JUNIPER ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2194
Mailing Address - Country:US
Mailing Address - Phone:321-439-8944
Mailing Address - Fax:
Practice Address - Street 1:1045 SOUTHCREST DR STE 100
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6119
Practice Address - Country:US
Practice Address - Phone:321-439-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS28604207V00000X
GA100544207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology