Provider Demographics
NPI:1700634870
Name:ABAZIE, UGOCHI CHIZUOROM (MD)
Entity type:Individual
Prefix:MRS
First Name:UGOCHI
Middle Name:CHIZUOROM
Last Name:ABAZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:UGOCHI
Other - Middle Name:CHIZUOROM
Other - Last Name:OKEREKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11 UPPER RIVERDALE ROAD SW
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274
Mailing Address - Country:US
Mailing Address - Phone:770-991-8026
Mailing Address - Fax:773-257-6027
Practice Address - Street 1:11 UPPER RIVERDALE ROAD SW
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:770-991-8026
Practice Address - Fax:773-257-6027
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2025-08-15
Deactivation Date:2025-01-13
Deactivation Code:
Reactivation Date:2025-08-14
Provider Licenses
StateLicense IDTaxonomies
IL125083174207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine