Healthcare Provider Details

I. General information

NPI: 1619443728
Provider Name (Legal Business Name): OLAOCHA BEATRICE OKWUADIGBO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 WESTRIDGE PKWY STE 221
MCDONOUGH GA
30253-3052
US

IV. Provider business mailing address

2400 LAKE ERMA DR
HAMPTON GA
30228-6083
US

V. Phone/Fax

Practice location:
  • Phone: 703-403-2505
  • Fax:
Mailing address:
  • Phone: 703-403-2505
  • Fax: 855-874-4592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME149581
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN27866
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number93536
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: