Active NPI
Clement Emeka Okpala, PHARMD
- Pharmacotherapy Pharmacist
- Fairburn, GA
National Provider Identifier
1326379280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- 014478
- Practice address
- 180 W Broad St Ste a
Fairburn, GA 30213 - Phone
- (678) 489-2069
- Fax
- (678) 489-8627
- NPI assigned
- Jan 15, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | 014478 | GA | Primary |
Addresses
Primary practice location
180 W Broad St Ste a
Fairburn, GA 30213
Mailing address
180 W Broad St Ste a
Fairburn, GA 30213
Phone (678) 489-2069
Other practice location 1
216 NW Broad St
Suite B
Fairburn, GA 30213-4106
Phone (678) 489-2069
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014478 | GA | MD | Pharmacotherapy Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Pharmacy Inc | Current | Accepting new patients | |
| Providence Care Inc | Past | Accepting new patients |
Locations
180 NW Broad St
Ste A
Fairburn, GA 30213
Phone (678) 489-2069
216 NW Broad St
Ste B
Fairburn, GA 30213
Phone (678) 489-2069
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Retail Pharmacy
- Fairburn, GA
- NPI 1942436027
-
- Community/Behavioral Health Agency
- Fairburn, GA
- NPI 1376805630
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613520000000",
"number": "1326379280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 W BROAD ST STE A",
"city": "FAIRBURN",
"state": "GA",
"postal_code": "30213",
"telephone_number": "678-489-2069",
"fax_number": "678-489-8627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "180 W BROAD ST STE A",
"city": "FAIRBURN",
"state": "GA",
"postal_code": "30213",
"telephone_number": "678-489-2069",
"fax_number": "678-489-8627"
}
],
"practiceLocations": [
{
"address_1": "216 NW Broad St",
"address_2": "Suite B",
"address_purpose": "LOCATION",
"city": "Fairburn",
"state": "GA",
"postal_code": "302134106",
"country_code": "US",
"telephone_number": "678-489-2069",
"fax_number": "678-489-8627",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OKPALA",
"first_name": "CLEMENT",
"middle_name": "EMEKA",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-01-15",
"last_updated": "2021-02-17",
"certification_date": "2021-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "GA",
"license": "014478",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairburn, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.