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
State | License ID | Taxonomies |
---|---|---|
GA | PT7824 | 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
GA | 65BBDSP | Medicare ID - Type Unspecified | |
GA | GRP7336 | Medicare ID - Type Unspecified | GROUP NUMBER |