Provider Demographics
NPI:1033226832
Name:OKAFOR, IFEOMA L (MD)
Entity Type:Individual
Prefix:
First Name:IFEOMA
Middle Name:L
Last Name:OKAFOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IFEOMA
Other - Middle Name:LAURA
Other - Last Name:AMOBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 740015
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0015
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:7028 HIGHWAY 85
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2946
Practice Address - Country:US
Practice Address - Phone:470-444-3136
Practice Address - Fax:470-298-7730
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060428208M00000X
GA60428207R00000X
ORMD210700208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM317AG1Medicare ID - Type Unspecified
NYI37365Medicare UPIN
NY02614217Medicaid