| Doctor Name: | DR. DONATUS OKECHUKWU MBANEFO |
| NPI Number: | 1649511999 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 069036 |
| Business Practice Address: | 1029 Cleveland Ave East Point, GA - 303446719 |
| Business Phone Number: | 4047913720 |
| Business Fax Number: | |
| Mailing Address: | 70 Harlan St, #205 SAN LEANDRO |
| State: | CA |
| Postal Code: | 945775864 |
| Phone Number: | 5108276643 |
| Fax Number: | |
| NPI Enumeration Date: | 03/12/2013 |
| NPI Last Update Date: | 03/12/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 069036 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |