Provider Demographics
NPI:1508948563
Name:OKORO, CASIMIR CHUKWUEMEKA (MD)
Entity Type:Individual
Prefix:
First Name:CASIMIR
Middle Name:CHUKWUEMEKA
Last Name:OKORO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7384 HIGHWAY 85
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-3453
Mailing Address - Country:US
Mailing Address - Phone:770-997-6644
Mailing Address - Fax:770-997-6630
Practice Address - Street 1:7384 HIGHWAY 85
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-3453
Practice Address - Country:US
Practice Address - Phone:770-997-6644
Practice Address - Fax:770-997-6630
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000544948JMedicaid
GA000544948JMedicaid
GAF59027Medicare UPIN
GA000544948JMedicaid