Individual
VINCE IFEANYI CHUKWUKELU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3780 EISENHOWER PKWY, MACON, GA 31206-0800
(478) 633-5550
(478) 633-7287
Mailing address
3780 EISENHOWER PKWY, MACON, GA 31206-0800
(478) 633-5550
(478) 633-7287
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
010544
GA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
90086
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2018
Last updated
06/27/2022
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