Provider Demographics
NPI:1730367756
Name:OKORO, NGOZI IVUNANYA (MD)
Entity type:Individual
Prefix:
First Name:NGOZI
Middle Name:IVUNANYA
Last Name:OKORO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HOWELL MILL RD NW
Mailing Address - Street 2:STE 600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-0920
Mailing Address - Country:US
Mailing Address - Phone:678-223-7726
Mailing Address - Fax:678-388-1759
Practice Address - Street 1:1800 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2538
Practice Address - Country:US
Practice Address - Phone:404-351-9512
Practice Address - Fax:404-351-9815
Is Sole Proprietor?:No
Enumeration Date:2008-01-31
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001486207R00000X
MN51221207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003110333Medicaid
GA202I8I2315OtherMEDICARE
MNENROLLEDMedicaid
MN100000783Medicare PIN