Provider Demographics
NPI:1154710010
Name:OKWANDU BELLO, IJEOMA
Entity type:Individual
Prefix:
First Name:IJEOMA
Middle Name:
Last Name:OKWANDU BELLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 LANIER AVE W STE 203
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1833
Mailing Address - Country:US
Mailing Address - Phone:678-990-9468
Mailing Address - Fax:
Practice Address - Street 1:600 LANIER AVE W STE 203
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1833
Practice Address - Country:US
Practice Address - Phone:678-990-9468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA146591207V00000X
390200000X
GA91046207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program