Healthcare Provider Details

I. General information

NPI: 1851380273
Provider Name (Legal Business Name): SAMUEL CHINWUBA OKOYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SAMUEL CHINWUBA OKOYE M.D.

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5429 ROBINSON ROAD EXT
JACKSON MS
39204-4138
US

IV. Provider business mailing address

300 MONTEREY DR
CLINTON MS
39056-5736
US

V. Phone/Fax

Practice location:
  • Phone: 601-914-0163
  • Fax: 601-914-0170
Mailing address:
  • Phone: 601-914-0163
  • Fax: 601-914-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13321
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: