Provider Demographics
NPI:1285427880
Name:EKE-OKORO, AMALACHUKWU
Entity type:Individual
Prefix:
First Name:AMALACHUKWU
Middle Name:
Last Name:EKE-OKORO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5476 LEGACY TRL
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-5849
Mailing Address - Country:US
Mailing Address - Phone:856-285-5857
Mailing Address - Fax:
Practice Address - Street 1:5476 LEGACY TRL
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-5849
Practice Address - Country:US
Practice Address - Phone:856-285-5857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR14639600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse