Basic Information
| Provider Information | |||||||||
| NPI: | 1073028536 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OKEH HEALTH GROUP, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3719 CASTEEL PARK DR SW | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300641692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708977043 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33 UPPER RIVERDALE RD SW | ||||||||
| Address2: | 17 | ||||||||
| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708977043 | ||||||||
| FaxNumber: | 7709963529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | OKEH | ||||||||
| AuthorizedOfficialFirstName: | VICTOR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 7708977043 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.