Provider Demographics
NPI:1366314213
Name:UKEGBU, KELECHI RUTH
Entity type:Individual
Prefix:
First Name:KELECHI
Middle Name:RUTH
Last Name:UKEGBU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5270 E FAIRVIEW RD SW
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5335
Mailing Address - Country:US
Mailing Address - Phone:470-779-2545
Mailing Address - Fax:
Practice Address - Street 1:5270 E FAIRVIEW RD SW
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5335
Practice Address - Country:US
Practice Address - Phone:470-779-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-20
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANP284853363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty