Basic Information
| Provider Information | |||||||||
| NPI: | 1528527488 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OKOYE | ||||||||
| FirstName: | IJEOMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 BENTBROOK CT | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302143334 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2001 VAIL AVE | ||||||||
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| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043047000 | ||||||||
| FaxNumber: | 7043047008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2019 | ||||||||
| LastUpdateDate: | 03/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 250058 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.