1932177102 NPI number — DR. PATRICIA CHINWENWA UBANI-EBERE MD

Table of content: DR. PATRICIA CHINWENWA UBANI-EBERE MD (NPI 1932177102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932177102 NPI number — DR. PATRICIA CHINWENWA UBANI-EBERE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UBANI-EBERE
Provider First Name:
PATRICIA
Provider Middle Name:
CHINWENWA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
UBANI-EBERE
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
CHINWENWA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1932177102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5995 SPRING STREET
Provider Second Line Business Mailing Address:
PO BOX 324
Provider Business Mailing Address City Name:
WARM SPRINGS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31830-0324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-672-0208
Provider Business Mailing Address Fax Number:
706-672-1593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7007 WILLIAMS STREET
Provider Second Line Business Practice Location Address:
SUITE C BOX 120
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-672-4818
Provider Business Practice Location Address Fax Number:
706-672-1593
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  042618 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 042618 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000719947AC , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000719947AG , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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