Healthcare Provider Details

I. General information

NPI: 1922453117
Provider Name (Legal Business Name): BENEDICTA N OKOYE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 BOREAL WAY SW
ATLANTA GA
30331
US

IV. Provider business mailing address

5401 BOREAL WAY SW
ATLANTA GA
30331-9215
US

V. Phone/Fax

Practice location:
  • Phone: 470-429-1431
  • Fax:
Mailing address:
  • Phone: 470-429-1431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN196505
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN196505
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2019072427
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: