Healthcare Provider Details

I. General information

NPI: 1073028536
Provider Name (Legal Business Name): OKEH HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 UPPER RIVERDALE RD SW 17
RIVERDALE GA
30274
US

IV. Provider business mailing address

3719 CASTEEL PARK DR SW
MARIETTA GA
30064-1692
US

V. Phone/Fax

Practice location:
  • Phone: 770-897-7043
  • Fax: 770-996-3529
Mailing address:
  • Phone: 770-897-7043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VICTOR OKEH
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 770-897-7043