Basic Information
Provider Information
NPI: 1750829123
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AKWIWU
FirstName: CHIKA
MiddleName: OKEM
NamePrefix: MRS.
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 742616
Address2:  
City: ATLANTA
State: GA
PostalCode: 303742616
CountryCode: US
TelephoneNumber: 7702198420
FaxNumber: 7702198440
Practice Location
Address1: 200 WISTERIA DR
Address2:  
City: GAINESVILLE
State: GA
PostalCode: 305013827
CountryCode: US
TelephoneNumber: 7702195407
FaxNumber: 7702197102
Other Information
ProviderEnumerationDate: 02/06/2017
LastUpdateDate: 03/30/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/30/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XRN217067GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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