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General NPI Number Information
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NPI Number | 1992922744
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Entity Type | Organization
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Legal Business Name | CENTRAL GEORGIA PEDIATRICS, INC.
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 844 2ND ST
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City | MACON
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State | GA
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Zip | 31201-6885
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Country | US
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Telephone | 478-746-6662
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Fax | 478-746-8861
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Provider Business Mailing Address
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Address Line | 844 2ND ST
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City | MACON
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State | GA
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Zip | 31201-6885
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Country | US
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Telephone | 478-746-6662
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Fax | 478-746-8861
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OBIOHA LOUIS OKORO
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Credential | M.D.
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Telephone | 478-746-6662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 039194
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License Number State | GA
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