Provider Demographics
NPI:1669448221
Name:UGWONALI, OBINWANNE FIDELIS C (MD)
Entity type:Individual
Prefix:DR
First Name:OBINWANNE
Middle Name:FIDELIS C
Last Name:UGWONALI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5505 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1705
Mailing Address - Country:US
Mailing Address - Phone:404-355-0743
Mailing Address - Fax:404-425-1071
Practice Address - Street 1:5505 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1705
Practice Address - Country:US
Practice Address - Phone:404-355-0743
Practice Address - Fax:404-425-1071
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2008-12-12
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Provider Licenses
StateLicense IDTaxonomies
GA057508207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA478817OtherTUFTS HEALTH PLAN
MAJ29526OtherBCBS MA
MA2112272Medicaid
MA478817OtherTUFTS HEALTH PLAN
I39464Medicare UPIN