Provider Demographics
NPI:1891110268
Name:OKOI CHUKWUNYERE, EDITH I
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:I
Last Name:OKOI CHUKWUNYERE
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 1:2337 GOODWOOD DR SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4335
Mailing Address - Country:US
Mailing Address - Phone:678-760-0752
Mailing Address - Fax:
Practice Address - Street 1:2337 GOODWOOD DR SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4335
Practice Address - Country:US
Practice Address - Phone:678-760-0752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ5019 (MDCN/R/20115)207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
U4232038702OtherCIGNA