Individual
DR. ISIOMA THERESA OKOBAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2505 PANOLA RD, SUITE A, LITHONIA, GA 30058-4831
(770) 323-6458
(770) 323-6462
Mailing address
2505 PANOLA RD, SUITE A, LITHONIA, GA 30058-4831
(770) 323-6458
(770) 323-6462
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
056611
GA
2084P0800X
Psychiatry Physician
056611
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
811209596A
—
GA
Enumeration date
08/23/2005
Last updated
09/14/2022
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