Provider Demographics
NPI:1447539564
Name:ANYANWU, CHIEDOZIE (PA)
Entity type:Individual
Prefix:MR
First Name:CHIEDOZIE
Middle Name:
Last Name:ANYANWU
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7165 WEATHERFORD DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-8007
Mailing Address - Country:US
Mailing Address - Phone:646-945-5031
Mailing Address - Fax:
Practice Address - Street 1:3350 RIVERWOOD PKWY SE STE 1850
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3300
Practice Address - Country:US
Practice Address - Phone:646-945-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014914363A00000X
GA008273363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant