Healthcare Provider Details

I. General information

NPI: 1407656549
Provider Name (Legal Business Name): EDWARD MADUABUCHI OKEKE MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2467 OLD CORNELIA HWY
GAINESVILLE GA
30507-7853
US

IV. Provider business mailing address

3009 SHIRECREST LN
DACULA GA
30019-1689
US

V. Phone/Fax

Practice location:
  • Phone: 678-960-2700
  • Fax: 678-513-5833
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP334320
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: