Provider Demographics
NPI:1730981234
Name:AZU, ONYAKA OBIARUKO
Entity type:Individual
Prefix:
First Name:ONYAKA
Middle Name:OBIARUKO
Last Name:AZU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 AVALON PKWY STE 360
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3088
Mailing Address - Country:US
Mailing Address - Phone:770-374-2302
Mailing Address - Fax:
Practice Address - Street 1:595 GARDINIA DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3910
Practice Address - Country:US
Practice Address - Phone:770-374-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062179528172A00000X
172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver