Healthcare Provider Details

I. General information

NPI: 1467451393
Provider Name (Legal Business Name): JOEL OKOLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR. DRIVE
ATLANTA GA
30303
US

IV. Provider business mailing address

75 PIEDMONT AVE STE 700
ATLANTA GA
30303-2544
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-4307
  • Fax: 404-616-1417
Mailing address:
  • Phone: 404-756-5764
  • Fax: 404-756-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number042681
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: