Provider Demographics
NPI:1811518327
Name:IKORO, UDUNMA NDUKA (MD)
Entity type:Individual
Prefix:MRS
First Name:UDUNMA
Middle Name:NDUKA
Last Name:IKORO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:179 PINE GROVE RD STE B
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-8490
Mailing Address - Country:US
Mailing Address - Phone:770-387-4544
Mailing Address - Fax:770-387-4579
Practice Address - Street 1:179 PINE GROVE RD STE B
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8490
Practice Address - Country:US
Practice Address - Phone:770-387-4544
Practice Address - Fax:770-387-4579
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA99192207R00000X
FLME-161144208D00000X
PAMT220205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice