Provider Demographics
NPI:1821356775
Name:IFECHUKWUDE, NNEAMAKA ANITA
Entity type:Individual
Prefix:MRS
First Name:NNEAMAKA
Middle Name:ANITA
Last Name:IFECHUKWUDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NNEAMAKA
Other - Middle Name:ANITA
Other - Last Name:UGBODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6325 HOSPITAL PKWY
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5775
Mailing Address - Country:US
Mailing Address - Phone:404-778-5361
Mailing Address - Fax:
Practice Address - Street 1:1200 NORTHSIDE FORSYTH DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7659
Practice Address - Country:US
Practice Address - Phone:770-844-3200
Practice Address - Fax:770-844-3227
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA074694207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine