Provider Demographics
NPI:1619463718
Name:OFFODILE, CHIOMA J
Entity Type:Individual
Prefix:
First Name:CHIOMA
Middle Name:J
Last Name:OFFODILE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7803 BAR HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-3370
Mailing Address - Country:US
Mailing Address - Phone:404-429-5597
Mailing Address - Fax:
Practice Address - Street 1:7803 BAR HARBOR DR
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-3370
Practice Address - Country:US
Practice Address - Phone:404-429-5597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-1829251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health