Individual
DR. SAMUEL IKECHUKWU OGBUCHI JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1412 MILSTEAD AVE NE, CONYERS, GA 30012-3877
(770) 918-3000
(404) 367-3558
Mailing address
1412 MILSTEAD AVE NE, CONYERS, GA 30012-3877
(770) 918-3000
(404) 367-3558
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
88897
GA
208M00000X
Hospitalist Physician
Primary
88897
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
GA
Other
Enumeration date
04/04/2018
Last updated
07/02/2021
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