Provider Demographics
NPI:1669017273
Name:OKOGBA, ELMA
Entity Type:Individual
Prefix:
First Name:ELMA
Middle Name:
Last Name:OKOGBA
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 1:4236 WEAVERS WHITE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8255
Mailing Address - Country:US
Mailing Address - Phone:404-421-8238
Mailing Address - Fax:
Practice Address - Street 1:4236 WEAVERS WHITE LN
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8255
Practice Address - Country:US
Practice Address - Phone:404-421-8238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN239488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily