Healthcare Provider Details

I. General information

NPI: 1922806876
Provider Name (Legal Business Name): CHIDIEBERE KINGSLEY OKAFOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4914 JOCKS LN
AUSTELL GA
30106-1753
US

IV. Provider business mailing address

4914 JOCKS LN
AUSTELL GA
30106-1753
US

V. Phone/Fax

Practice location:
  • Phone: 404-951-9148
  • Fax:
Mailing address:
  • Phone: 404-951-9148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberPHCP013165
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: