Provider Demographics
NPI:1497772438
Name:OKAFOR, ANGELA NKOLI (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:NKOLI
Last Name:OKAFOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:NKOLI
Other - Last Name:MBANUGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:7130 MOUNT ZION BLVD
Practice Address - Street 2:SUITE 9
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2566
Practice Address - Country:US
Practice Address - Phone:770-603-5560
Practice Address - Fax:770-603-6779
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT7824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA65BBDSPMedicare ID - Type Unspecified
GAGRP7336Medicare ID - Type UnspecifiedGROUP NUMBER