Individual
MR. THEODORE O ANUEBUNWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2801 DEKALB MEDICAL PKWY, LITHONIA, GA 30058-4996
(404) 501-8492
Mailing address
2801 DEKALB MEDICAL PKWY, LITHONIA, GA 30058-4996
(404) 501-8492
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
063757
GA
207R00000X
Internal Medicine Physician
4301082889
MI
208M00000X
Hospitalist Physician
Primary
063757
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4560846
—
MI
Enumeration date
12/01/2005
Last updated
11/12/2018
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