Provider Demographics
NPI:1922032226
Name:OKOYE, CHUDY NATHANIEL
Entity Type:Individual
Prefix:DR
First Name:CHUDY
Middle Name:NATHANIEL
Last Name:OKOYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 VOEGLIN AVE
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36703-4322
Mailing Address - Country:US
Mailing Address - Phone:334-875-1478
Mailing Address - Fax:334-875-1479
Practice Address - Street 1:1203 VOEGLIN AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36703-4322
Practice Address - Country:US
Practice Address - Phone:334-875-1478
Practice Address - Fax:334-875-1479
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL7286208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000051145Medicaid
AL51051145OtherBCBS
AL000051145Medicare ID - Type Unspecified