Provider Demographics
NPI:1518471499
Name:OKORO, PAUL OBINNA (APRN,MSN,RN,NP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:OBINNA
Last Name:OKORO
Suffix:
Gender:M
Credentials:APRN,MSN,RN,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 GREENHOUSE PATIO DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5522
Mailing Address - Country:US
Mailing Address - Phone:678-571-5960
Mailing Address - Fax:
Practice Address - Street 1:3030 MCEVER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-5579
Practice Address - Country:US
Practice Address - Phone:678-450-0747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF08170344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily