Healthcare Provider Details

I. General information

NPI: 1255444063
Provider Name (Legal Business Name): STANLEY A OKORO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 11/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 ASQUITH AVE SW SUITE 200
MARIETTA GA
30008-6008
US

IV. Provider business mailing address

P. O. BOX 388 GEORGIA PLASTIC & RECONSTRUCTIVE SURGERY
SMYRNA GA
30081
US

V. Phone/Fax

Practice location:
  • Phone: 770-485-1554
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number044295
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: