=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124490438
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IMMACULATA CHIMEZIE OKERE NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2015
-----------------------------------------------------
Last Update Date | 02/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 56 JESSE HILL JR DRIVE
-----------------------------------------------------
City | SOUTHEAST, ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-616-6661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O BOX 26178 80 JESSE HILL JR. DRIVE SE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-616-6680
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN131127
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------