Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 21430 | SC |
NPI | 1023087756 |
---|---|
Provider Name | Jonathan O Nwanagu |
First Address | Columbia, SC 29202-7481 |
Second Address | Columbia, SC 29201-2947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 01/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G00211 | (02) |