Healthcare Provider Details

I. General information

NPI: 1518471499
Provider Name (Legal Business Name): PAUL OBINNA OKORO APRN,MSN,RN,NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 MCEVER RD
GAINESVILLE GA
30504-5579
US

IV. Provider business mailing address

1224 GREENHOUSE PATIO DR NW
KENNESAW GA
30144-5522
US

V. Phone/Fax

Practice location:
  • Phone: 678-450-0747
  • Fax:
Mailing address:
  • Phone: 678-571-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08170344
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: