Healthcare Provider Details

I. General information

NPI: 1922845460
Provider Name (Legal Business Name): MR. EMMANUEL OKOYE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W I PKWY STE 307
DALLAS GA
30132-5101
US

IV. Provider business mailing address

4453 WESLEY WAY
AUSTELL GA
30106-1681
US

V. Phone/Fax

Practice location:
  • Phone: 844-762-8726
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: