Healthcare Provider Details

I. General information

NPI: 1013767201
Provider Name (Legal Business Name): MUNACHUKWUDI AFAMEFUNA OKOYE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UNION AVE
MEMPHIS TN
38104-3415
US

IV. Provider business mailing address

1265 UNION AVE
MEMPHIS TN
38104-3415
US

V. Phone/Fax

Practice location:
  • Phone: 910-516-8279
  • Fax:
Mailing address:
  • Phone: 910-516-8279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: