Provider Demographics
NPI:1720242720
Name:ANYOKWU, OKAH JUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:OKAH
Middle Name:JUSTIN
Last Name:ANYOKWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:880 MARIETTA HWY STE 630366
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6755
Mailing Address - Country:US
Mailing Address - Phone:770-644-1570
Mailing Address - Fax:
Practice Address - Street 1:1810 MULKEY RD STE 202
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1150
Practice Address - Country:US
Practice Address - Phone:770-694-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20080099362084P0800X
GA0787012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO152360642Medicare PIN