Provider Demographics
NPI:1295770436
Name:OKONOFUA, ENI CLEMENT (MB,BS)
Entity type:Individual
Prefix:DR
First Name:ENI
Middle Name:CLEMENT
Last Name:OKONOFUA
Suffix:
Gender:M
Credentials:MB,BS
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Mailing Address - Street 1:5390 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-5652
Mailing Address - Country:US
Mailing Address - Phone:843-552-3099
Mailing Address - Fax:843-552-3277
Practice Address - Street 1:5390 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-5652
Practice Address - Country:US
Practice Address - Phone:843-552-3099
Practice Address - Fax:846-559-9037
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2019-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC21076207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT53518Medicaid
SC134323946OtherBCBS OF SC