Provider Demographics
NPI:1720243751
Name:ANIGBOGU, IFEYINWA (MD)
Entity Type:Individual
Prefix:
First Name:IFEYINWA
Middle Name:
Last Name:ANIGBOGU
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 1:125 COLD CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5531
Mailing Address - Country:US
Mailing Address - Phone:917-374-5291
Mailing Address - Fax:
Practice Address - Street 1:8570 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2413
Practice Address - Country:US
Practice Address - Phone:470-227-8130
Practice Address - Fax:470-747-7588
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036134126207R00000X
NC2015-01318207RN0300X
SC52181207RN0300X
GA90231207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine