Nnennaya O Agwu, APRN
Individual provider Active NPI Family Nurse Practitioner · Savannah, GA
NPI 1639959166 · NPPES record last updated Dec 3, 2024
Key facts
- NPI
- 1639959166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 29072 (SC)
- Practice address
- 6711 La Roche Ave
Savannah, GA 31406-3101 - Phone
- (912) 354-8225
- NPI assigned
- Oct 2, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- University of South Carolina School of Medicine, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Che Behavioral Health Services of South Carolina PC
Theoria Medical
Practice addresses (Care Compare)
220 N Main St
Suite 500
Greenville, SC 29601-2129
Phone (800) 275-3243
6711 La Roche Ave
Savannah, GA 31406-3101
Phone (248) 660-1220
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA, SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250107001730 | GA | Practitioner - Nurse Practitioner | 5395273163 | Reassigns benefits to 2 organizations |
| I20250514001791 | SC | Practitioner - Nurse Practitioner | 5395273163 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Arts, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| GAA-NP002631 | GA | MD | Family Nurse Practitioner |
| 29072 | SC | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Theoria Medical | Current |
Accepting new patients | |
| Complexcare Medical Group Midwest M PLLC | Current |
Accepting new patients | |
| Che Behavioral Health Services of South Carolina, P.C. | Current |
Accepting new patients |
Locations
4000 Village View Dr
Gainesville, GA 30506
Phone (678) 450-3000
6711 La Roche Ave
Savannah, GA 31406
Phone (912) 354-8225
7300 Lester Rd
Union City, GA 30291
Phone (770) 703-2604
41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763
220 N Main St
Ste 500
Greenville, SC 29601
Phone (347) 294-3414
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | GAA-NP002631 | GA | |
| Family Nurse Practitioner | 363LF0000X | 29072 | SC | Yes |
Addresses
Primary practice location
6711 La Roche Ave
Savannah, GA 31406-3101
Mailing address
1601 Green Street Columbia
Columbia, SC 29208-0001
Other providers in Savannah, GA
- Wuraola Afolabi
- Agape Behavioral Specialist
- Agape Specialty Care Center Inc.
- Jensen Aguinaldo
- Itunu Jumoke Agunbiade
- Victoria M Agyekum
- Dora A. Agyemang
- Jeanette Agyemang
- William Opoku Badu Agyemang
- Susan Ahle
All providers in Savannah, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2024. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.