Provider Demographics
NPI:1902921711
Name:ANYAKWO, GERTRUDE N (MD)
Entity Type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:N
Last Name:ANYAKWO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 HENRY CLOWER BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-7418
Mailing Address - Country:US
Mailing Address - Phone:470-545-5551
Mailing Address - Fax:470-545-9031
Practice Address - Street 1:2311 HENRY CLOWER BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7418
Practice Address - Country:US
Practice Address - Phone:470-545-5551
Practice Address - Fax:470-545-9031
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL 29101207V00000X
GA65078207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA346213607Medicaid
GA346213607Medicaid