Healthcare Provider Details

I. General information

NPI: 1174707764
Provider Name (Legal Business Name): BEATRICE NWANNEKA OKOLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 09/11/2025
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 MANCHESTER EXPY
COLUMBUS GA
31904-6878
US

IV. Provider business mailing address

2122 MANCHESTER EXPY
COLUMBUS GA
31904-6878
US

V. Phone/Fax

Practice location:
  • Phone: 706-590-8781
  • Fax:
Mailing address:
  • Phone: 770-337-0541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5258
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: