Healthcare Provider Details

I. General information

NPI: 1730367756
Provider Name (Legal Business Name): NGOZI IVUNANYA OKORO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HOWELL MILL RD NW SUITE 600
ATLANTA GA
30318-2538
US

IV. Provider business mailing address

1800 HOWELL MILL RD NW STE 600
ATLANTA GA
30318-0920
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-9512
  • Fax: 404-351-9815
Mailing address:
  • Phone: 678-223-7726
  • Fax: 678-388-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number001486
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number51221
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: