Healthcare Provider Details

I. General information

NPI: 1457843567
Provider Name (Legal Business Name): CHARLES I OKAFOR PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 TYSON AVE
PARIS TN
38242-4544
US

IV. Provider business mailing address

8123 WAVERLY XING
GERMANTOWN TN
38138-7540
US

V. Phone/Fax

Practice location:
  • Phone: 731-642-1220
  • Fax:
Mailing address:
  • Phone: 504-333-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: