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Organization
IVY LEAGUE PEDIATRICS
Active
Organization
IVY LEAGUE PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NNEKA UNACHUKWU (MD)
(678) 407-4489
Entity
Organization
Contact information
Practice address
601 OLD NORCROSS RD, STE B, LAWRENCEVILLE, GA 30046-4311
(678) 407-4489
Mailing address
601 OLD NORCROSS RD, STE B, LAWRENCEVILLE, GA 30046-4311
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
061715
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
56042500B
—
GA
Enumeration date
09/30/2011
Last updated
09/30/2011
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