MEDICARE: GLORIA EBERECHUKWU OKOYE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN189783	GA

General Provider Information

NPI Number	:	1437694205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA EBERECHUKWU OKOYE FNP

Provider Business Mailing Address
First Line	:	3653 BELGRAY DR NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30152-6995
Country	:	US
Telephone Number	:	310-384-3058
Fax Number	:

Provider Business Practice Location Address
First Line	:	632 ROCK HILL PKWY
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-3657
Country	:	US
Telephone Number	:	310-384-3058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	03/03/2026

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