Provider Demographics
NPI:1407925324
Name:OKPALA, OGOCHUKWU C (MD, MPH, MBA)
Entity Type:Individual
Prefix:DR
First Name:OGOCHUKWU
Middle Name:C
Last Name:OKPALA
Suffix:
Gender:F
Credentials:MD, MPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-0102
Mailing Address - Country:US
Mailing Address - Phone:912-559-2432
Mailing Address - Fax:
Practice Address - Street 1:228 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0102
Practice Address - Country:US
Practice Address - Phone:912-559-2432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-02466207V00000X, 2084A0401X
KYTP247207V00000X
MA218822207V00000X
DEC1-0010009207V00000X
KY54046207V00000X
KY54045207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE02289C61Medicare PIN