Provider Demographics
NPI:1619443728
Name:OKWUADIGBO, OLAOCHA BEATRICE (MD)
Entity Type:Individual
Prefix:DR
First Name:OLAOCHA
Middle Name:BEATRICE
Last Name:OKWUADIGBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 LAKE ERMA DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6083
Mailing Address - Country:US
Mailing Address - Phone:703-403-2505
Mailing Address - Fax:855-874-4592
Practice Address - Street 1:155 WESTRIDGE PKWY STE 221
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3052
Practice Address - Country:US
Practice Address - Phone:703-403-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1495812084P0800X
FLTRN27866390200000X
GA935362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program