Provider Demographics
NPI:1558583658
Name:OKAFOR, OBIAJULU C (MD)
Entity Type:Individual
Prefix:
First Name:OBIAJULU
Middle Name:C
Last Name:OKAFOR
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 1:2201 TALMADGE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-1608
Mailing Address - Country:US
Mailing Address - Phone:678-593-4666
Mailing Address - Fax:678-593-4665
Practice Address - Street 1:2201 TALMADGE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-1608
Practice Address - Country:US
Practice Address - Phone:678-593-4666
Practice Address - Fax:678-593-4665
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA62269207VG0400X, 207VX0000X, 207R00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30025722Medicare PIN
TN1517134Medicaid
TN4005905OtherBLUE CROSS BLUE SHIELD