Healthcare Provider Details

I. General information

NPI: 1952237000
Provider Name (Legal Business Name): UGONNA OKEKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905A S FRONTAGE RD
MERIDIAN MS
39301-6113
US

IV. Provider business mailing address

905A S FRONTAGE RD
MERIDIAN MS
39301-6113
US

V. Phone/Fax

Practice location:
  • Phone: 601-484-2793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number123456
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: