Provider Demographics
NPI:1033363718
Name:CHUKWUKA, CONSTANCE (RD)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:CHUKWUKA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4057 MEDLOCK WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-2722
Mailing Address - Country:US
Mailing Address - Phone:973-444-8181
Mailing Address - Fax:908-998-2054
Practice Address - Street 1:1350 SCENIC HWY N, SUITE 266, RM 203
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7924
Practice Address - Country:US
Practice Address - Phone:973-444-8181
Practice Address - Fax:908-998-2054
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-08
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005717133V00000X
NJ974378133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty