Provider Demographics
NPI:1790045151
Name:UZOCHUKWU, CHINAZOR EBELECHUKWU (MD)
Entity type:Individual
Prefix:DR
First Name:CHINAZOR
Middle Name:EBELECHUKWU
Last Name:UZOCHUKWU
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 1:603 OLD NORCROSS RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4315
Mailing Address - Country:US
Mailing Address - Phone:678-407-4489
Mailing Address - Fax:
Practice Address - Street 1:603 OLD NORCROSS RD STE A
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4315
Practice Address - Country:US
Practice Address - Phone:678-407-4489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-19
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2015-0779208000000X
GA90685208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM28528531Medicaid