Nonyelu A Chukwuogo, M.D.
Individual provider Active NPI Surgery Physician · Huntingdon, TN
NPI 1295813699 · NPPES record last updated May 13, 2019
Key facts
- NPI
- 1295813699
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- MD45034 (TN)
- Practice address
- 631 RB Wilson Dr Ste 2
Huntingdon, TN 38344-1727 - Phone
- (731) 358-4287
- Fax
- (731) 393-0098
- NPI assigned
- Nov 2, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091123000232 | TN | Practitioner - General Surgery |
5193717163 |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20469 | OK | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Morehouse Ouachita Surgery Associates | Current |
Accepting new patients |
Locations
631 Rb Wilson Dr
Ste 2
Huntingdon, TN 38344
Phone (731) 358-4287
451 Highway 13 S
Waverly, TN 37185
Phone (931) 296-0211
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD45034 | TN | Yes |
Addresses
Primary practice location
631 RB Wilson Dr Ste 2
Huntingdon, TN 38344-1727
Mailing address
631 RB Wilson Dr Ste 2
Huntingdon, TN 38344-1727
Phone (731) 358-4287
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q048223 | Medicaid | TN | |
| 1516071 | Medicaid | TN |
Other providers in Huntingdon, TN
- Susan H Cary
- Danna Smith Castleman
- Kaye Cathey
- Charles a Thomason
- Zachary Scott Chrisman
- City Drug Company, Inc
- Clinical Radiologists, PLLC
- Cindy A Cole
- Tori Crider
- Kaitlyn Joyce Douglas
All providers in Huntingdon, TN · Surgery Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.