Healthcare Provider Details

I. General information

NPI: 1679204903
Provider Name (Legal Business Name): ADAOBI OKOCHA MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 YORKTOWN DR STE 102
FAYETTEVILLE GA
30214-1578
US

IV. Provider business mailing address

101 YORKTOWN DR STE 102
FAYETTEVILLE GA
30214-1578
US

V. Phone/Fax

Practice location:
  • Phone: 770-460-4281
  • Fax:
Mailing address:
  • Phone: 770-460-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTRN35628
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number103346
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: