Andrew C Agwunobi, MD

Individual provider Active NPI Pediatrics Physician · Peachtree City, GA

NPI 1336214931 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1336214931
Entity type
Individual (NPI type 1)
Primary specialty
Pediatrics Physician 208000000X
License
050336 (GA)
Practice address
526 Crosstown Rd
Peachtree City, GA 30269-2916
Phone
(770) 692-1914
Fax
(770) 692-1919
NPI assigned
Nov 21, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Health E Station Past
since Dec 1, 2006
Accepting new patients
Dignity Health Past
since Sep 1, 2008
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 050336 GA Yes

Addresses

Primary practice location

526 Crosstown Rd
Peachtree City, GA 30269-2916

Mailing address

526 Crosstown Rd
Peachtree City, GA 30269-2916
Phone (770) 692-1914

Other providers in Peachtree City, GA

All providers in Peachtree City, GA · Pediatrics Physician in Georgia

Sources for this page

Verify at the official NPI Registry.