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: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 SOUTHCREST DR STE 115
STOCKBRIDGE GA
30281-6104
US

IV. Provider business mailing address

1035 SOUTHCREST DR STE 115
STOCKBRIDGE GA
30281-6104
US

V. Phone/Fax

Practice location:
  • Phone: 678-884-1974
  • Fax: 678-884-0842
Mailing address:
  • Phone: 678-884-1974
  • Fax: 678-884-0842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number93536
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME149581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: