Provider Demographics
NPI:1346747862
Name:OKOH, CHINEDU KENNARD
Entity Type:Individual
Prefix:MR
First Name:CHINEDU
Middle Name:KENNARD
Last Name:OKOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 VALLEY FORGE PL NW # 19
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1455
Mailing Address - Country:US
Mailing Address - Phone:404-641-8500
Mailing Address - Fax:
Practice Address - Street 1:19 VALLEY FORGE PL NW # 19
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-1455
Practice Address - Country:US
Practice Address - Phone:404-641-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-17-38771106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician