Healthcare Provider Details

I. General information

NPI: 1447489026
Provider Name (Legal Business Name): VICTOR C NJOKU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2009
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 S 8TH ST
GRIFFIN GA
30224-4214
US

IV. Provider business mailing address

614 S 8TH ST
GRIFFIN GA
30224-4214
US

V. Phone/Fax

Practice location:
  • Phone: 678-688-8140
  • Fax:
Mailing address:
  • Phone: 678-688-8140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number076291
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: