Provider Demographics
NPI:1053581652
Name:UGWU, DONNA J
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:UGWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 HIGHWAY 138 APT 2123
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-6507
Mailing Address - Country:US
Mailing Address - Phone:770-629-2580
Mailing Address - Fax:678-519-3692
Practice Address - Street 1:5250 HIGHWAY 138 APT 2123
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-6507
Practice Address - Country:US
Practice Address - Phone:770-629-2580
Practice Address - Fax:678-519-3692
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R0317372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion