Provider Demographics
NPI:1588891261
Name:NWOKE, MARY OLUWATOMILOLA
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:OLUWATOMILOLA
Last Name:NWOKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:OLUWATOMILOLA
Other - Last Name:OLUWATIMILEHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3330 CUMBERLAND BLVD SE STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5997
Mailing Address - Country:US
Mailing Address - Phone:770-740-2611
Mailing Address - Fax:770-800-3100
Practice Address - Street 1:3330 CUMBERLAND BLVD SE STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5997
Practice Address - Country:US
Practice Address - Phone:770-740-2611
Practice Address - Fax:770-800-3100
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA068460207R00000X
GA68460208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine