Healthcare Provider Details

I. General information

NPI: 1003790551
Provider Name (Legal Business Name): UZOAMAKA P OKONKWO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HOGANSVILLE RD
LAGRANGE GA
30241-1422
US

IV. Provider business mailing address

PO BOX 56
DALLAS GA
30132-0001
US

V. Phone/Fax

Practice location:
  • Phone: 706-803-7390
  • Fax:
Mailing address:
  • Phone: 404-707-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN310199
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN310199
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN310199
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: