Healthcare Provider Details

I. General information

NPI: 1053186973
Provider Name (Legal Business Name): DR. SYLVIA CHIDINMA-NNENA OKOMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W COURT SQ
DECATUR GA
30030-2538
US

IV. Provider business mailing address

4943 MOUNTAINSIDE TRL
STONE MOUNTAIN GA
30083-3697
US

V. Phone/Fax

Practice location:
  • Phone: 678-333-4630
  • Fax:
Mailing address:
  • Phone: 678-333-4630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: