Provider Demographics
NPI:1770324352
Name:UGBAJA, EMMANUEL A
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:A
Last Name:UGBAJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 BEAVER RUIN RD STE 302
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3867
Mailing Address - Country:US
Mailing Address - Phone:678-334-3116
Mailing Address - Fax:770-305-6281
Practice Address - Street 1:1254 BEAVER RUIN RD STE 302
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3867
Practice Address - Country:US
Practice Address - Phone:678-334-3116
Practice Address - Fax:770-305-6281
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide