Provider Demographics
NPI:1649511999
Name:MBANEFO, DONATUS OKECHUKWU (MD)
Entity type:Individual
Prefix:DR
First Name:DONATUS
Middle Name:OKECHUKWU
Last Name:MBANEFO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 HARLAN ST
Mailing Address - Street 2:#205
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5864
Mailing Address - Country:US
Mailing Address - Phone:510-827-6643
Mailing Address - Fax:
Practice Address - Street 1:1029 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6719
Practice Address - Country:US
Practice Address - Phone:404-791-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069036208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice