Provider Demographics
NPI:1932351996
Name:AHIABUIKE, SMITHSON ONYEBUCHI (MD,)
Entity Type:Individual
Prefix:DR
First Name:SMITHSON
Middle Name:ONYEBUCHI
Last Name:AHIABUIKE
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S 3RD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5306
Mailing Address - Country:US
Mailing Address - Phone:256-438-5107
Mailing Address - Fax:256-438-5108
Practice Address - Street 1:525 S 3RD ST
Practice Address - Street 2:SUITE D
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5306
Practice Address - Country:US
Practice Address - Phone:256-438-5107
Practice Address - Fax:256-438-5108
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44150207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00280112Medicare PIN