Provider Demographics
NPI:1720043276
Name:NWOZO, OKEY C (MD)
Entity Type:Individual
Prefix:
First Name:OKEY
Middle Name:C
Last Name:NWOZO
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 1:3069 AMWILER RD STE 8
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30360-2825
Mailing Address - Country:US
Mailing Address - Phone:770-441-1617
Mailing Address - Fax:770-441-1220
Practice Address - Street 1:3069 AMWILER RD STE 8
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30360-2825
Practice Address - Country:US
Practice Address - Phone:770-441-1617
Practice Address - Fax:770-441-1220
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047005207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G93509Medicare UPIN