Healthcare Provider Details

I. General information

NPI: 1467954537
Provider Name (Legal Business Name): CHINYERE OLIVIA OKONKWO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 SUGARLOAF CIR STE 575
DULUTH GA
30097-9804
US

IV. Provider business mailing address

2055 SUGARLOAF CIR STE 575
DULUTH GA
30097-9804
US

V. Phone/Fax

Practice location:
  • Phone: 404-999-7971
  • Fax: 678-534-2045
Mailing address:
  • Phone: 404-999-7971
  • Fax: 678-534-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP216995
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN216995
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: