Provider Demographics
NPI:1376821975
Name:NNAMUCHI, LILIAN C (MD)
Entity type:Individual
Prefix:
First Name:LILIAN
Middle Name:C
Last Name:NNAMUCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LILIAN
Other - Middle Name:C
Other - Last Name:UDEANI COE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1826 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3620
Mailing Address - Country:US
Mailing Address - Phone:478-272-1210
Mailing Address - Fax:
Practice Address - Street 1:1826 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3620
Practice Address - Country:US
Practice Address - Phone:478-272-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-30
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA90109207Q00000X, 207Q00000X
IL036-134285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036134285 1Medicaid
WI1378621975OtherBCBSWI
WIUDEANLILOtherMERCYCARE INSURANCE
WIUDEANLILOtherMERCYCARE INSURANCE