Provider Demographics
NPI:1487653713
Name:AKPOLO, CHARITY OMEJIYOVBI (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:OMEJIYOVBI
Last Name:AKPOLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARITY
Other - Middle Name:OMEJIYOVBI
Other - Last Name:ITURU-AKPOLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:191-243-5555
Mailing Address - Fax:191-243-5954
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5604
Practice Address - Country:US
Practice Address - Phone:912-435-5555
Practice Address - Fax:912-435-5954
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050025208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics