Healthcare Provider Details

I. General information

NPI: 1689020612
Provider Name (Legal Business Name): JEFFREY OKONYE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 CLIFTON RD NE
ATLANTA GA
30322-7593
US

IV. Provider business mailing address

1547 CLIFTON RD NE FL 2
ATLANTA GA
30322-4008
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-7142
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number82392
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number218162
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number82391
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: