Provider Demographics
NPI:1174326680
Name:ALAEZI OKORONKWO, WILLIAMS IFEANYI
Entity type:Individual
Prefix:
First Name:WILLIAMS
Middle Name:IFEANYI
Last Name:ALAEZI OKORONKWO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 IVY BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-5855
Mailing Address - Country:US
Mailing Address - Phone:678-334-8355
Mailing Address - Fax:
Practice Address - Street 1:1954 IVY BRANCH LN
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-5855
Practice Address - Country:US
Practice Address - Phone:678-334-8355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2025215566171WV0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications