Provider Demographics
NPI:1043834732
Name:IGBOKWE, LINUS IKECHUKWU (MD)
Entity type:Individual
Prefix:DR
First Name:LINUS
Middle Name:IKECHUKWU
Last Name:IGBOKWE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 NEWPOINT PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6003
Mailing Address - Country:US
Mailing Address - Phone:678-257-7078
Mailing Address - Fax:
Practice Address - Street 1:2505 NEWPOINT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-6003
Practice Address - Country:US
Practice Address - Phone:678-257-7078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101230207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine