Healthcare Provider Details

I. General information

NPI: 1770226367
Provider Name (Legal Business Name): TED OBERAIFO AKHIWU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date: 01/18/2023
Reactivation Date: 01/18/2023

III. Provider practice location address

1365 CLIFTON RD, EMORY UNIVERISTY HOSPITAL
ATLANTA GA
30322
US

IV. Provider business mailing address

1365 CLIFTON RD NE
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-1722
  • Fax: 404-251-1899
Mailing address:
  • Phone: 404-712-1722
  • Fax: 404-251-1899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD0102448
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: