Provider Demographics
NPI:1912501800
Name:UWE, NGOZI
Entity Type:Individual
Prefix:
First Name:NGOZI
Middle Name:
Last Name:UWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 AZALEA ALEE CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4124
Mailing Address - Country:US
Mailing Address - Phone:770-718-7371
Mailing Address - Fax:
Practice Address - Street 1:1541 GEORGIA HIGHWAY 20 NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3834
Practice Address - Country:US
Practice Address - Phone:770-929-0310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist