Provider Demographics
NPI:1659328805
Name:UWAGERIKPE, LOUIS A (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:A
Last Name:UWAGERIKPE
Suffix:
Gender:M
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:PO BOX 3103
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604-3103
Mailing Address - Country:US
Mailing Address - Phone:229-247-9833
Mailing Address - Fax:229-247-9835
Practice Address - Street 1:3332 BEMISS RD
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7014
Practice Address - Country:US
Practice Address - Phone:229-247-9833
Practice Address - Fax:229-247-9835
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA56779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64109622Medicaid
GA237806355AMedicaid
KY0992001Medicare ID - Type Unspecified
GA237806355AMedicaid
GA08CBCGFMedicare PIN