Healthcare Provider Details

I. General information

NPI: 1467348698
Provider Name (Legal Business Name): ANDY D OKODOGBE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 SATELLITE BLVD STE 400
DULUTH GA
30097-4927
US

IV. Provider business mailing address

2180 SATELLITE BLVD STE 400
DULUTH GA
30097-4927
US

V. Phone/Fax

Practice location:
  • Phone: 404-457-7668
  • Fax:
Mailing address:
  • Phone: 404-457-7668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: