Provider Demographics
NPI:1104092048
Name:OKEH, VICTOR EZINNA (MD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:EZINNA
Last Name:OKEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:483 UPPER RIVERDALE RD SW STE F
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2579
Mailing Address - Country:US
Mailing Address - Phone:770-742-3883
Mailing Address - Fax:855-597-8504
Practice Address - Street 1:483 UPPER RIVERDALE RD SW STE F
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:770-742-3883
Practice Address - Fax:855-597-8504
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA071268207R00000X
FLME109619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME109619OtherMEDICAL LICENSE