MEDICARE: MRS. CHYCHY A OKOLI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1932375888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHYCHY A OKOLI

Provider Business Mailing Address
First Line	:	3875 POWDER SPRINGS RD
Second Line	:	SUITE C-3
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2759
Country	:	US
Telephone Number	:	404-216-8202
Fax Number	:	770-943-0818

Provider Business Practice Location Address
First Line	:	3875 POWDER SPRINGS RD
Second Line	:	SUITE C-3
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2759
Country	:	US
Telephone Number	:	404-216-8202
Fax Number	:	770-943-0818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/01/2008

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