Healthcare Provider Details

I. General information

NPI: 1518377829
Provider Name (Legal Business Name): STELLA IFEOMA OKOYE M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: IFEOMA STELLA-MARIS OLISAH M.D

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD RM 5C129
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

201 BRIDGECREEK DR
COLUMBIA SC
29229-8911
US

V. Phone/Fax

Practice location:
  • Phone: 803-776-4000
  • Fax:
Mailing address:
  • Phone: 580-458-7545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number39110
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: