Provider Demographics
NPI:1427070879
Name:OKPAKU, SAMUEL OSIFO (MDPHD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:OSIFO
Last Name:OKPAKU
Suffix:
Gender:M
Credentials:MDPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 17TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-2801
Mailing Address - Country:US
Mailing Address - Phone:615-329-4182
Mailing Address - Fax:
Practice Address - Street 1:1233 17TH AVE S
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2801
Practice Address - Country:US
Practice Address - Phone:615-329-4182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN183272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0083151OtherBLUE CROSS
TN3036819Medicaid
TN0083151OtherBLUE CROSS
TN3036817Medicare ID - Type UnspecifiedMEDICARE