Provider Demographics
NPI: | 1982916763 |
---|---|
Name: | OKAFOR, CHIMALUM RICHARD (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | CHIMALUM |
Middle Name: | RICHARD |
Last Name: | OKAFOR |
Suffix: | |
Gender: | |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 270 17TH ST NW UNIT 2413 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30363-1255 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 646-573-5431 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1005 DR DB TODD JR BLVD |
Practice Address - Street 2: | |
Practice Address - City: | NASHVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37208-3599 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-327-6611 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2010-07-08 |
Last Update Date: | 2025-02-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 45924 | 207R00000X, 208M00000X |
FL | ME139821 | 207R00000X, 208M00000X |
GA | 07716 | 208M00000X |
TN | 49983 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 7100250540 | Medicaid | |
KY | K118320 | Medicare PIN |