Provider Demographics
NPI:1154681567
Name:OFOHA, KENNETH ONYEKWERE (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ONYEKWERE
Last Name:OFOHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 492110
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0036
Mailing Address - Country:US
Mailing Address - Phone:678-442-9486
Mailing Address - Fax:
Practice Address - Street 1:401 W PIKE ST
Practice Address - Street 2:SUITE A & B
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4845
Practice Address - Country:US
Practice Address - Phone:678-442-9486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68463207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine