Individual
DR. NOWOGHOMWENMA CHARLES IBIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
207 HAVEN DR, DOTHAN, AL 36301-2919
(334) 793-3319
(334) 793-2291
Mailing address
207 HAVEN DR, DOTHAN, AL 36301-2919
(334) 793-3319
(334) 793-2291
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD.30540
AL
207R00000X
Internal Medicine Physician
30540
AL
207RN0300X
Nephrology Physician
Primary
MD.30540
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073742953
TRICARE SOUTH
AL
05
—
125314
—
AL
01
—
511-12500
BCBS
AL
01
—
Z14079
VIVA HEALTH
AL
Enumeration date
07/13/2009
Last updated
03/08/2017
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