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General NPI Number Information
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NPI Number | 1851380273
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Entity Type | Individual
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Provider Name | SAMUEL CHINWUBA OKOYE MD
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Gender | Male
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 11/19/2010
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Provider Practice Location Address
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Address Line | 5429 ROBINSON ROAD EXT
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City | JACKSON
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State | MS
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Zip | 39204-4138
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Country | US
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Telephone | 601-914-0163
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Fax | 601-914-0170
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Provider Business Mailing Address
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Address Line | 300 MONTEREY DR
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City | CLINTON
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State | MS
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Zip | 39056-5736
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Country | US
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Telephone | 601-914-0163
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Fax | 601-914-0170
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 13321
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License Number State | MS
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