Doctor Name: | AFUSAT OMOLARA ADEYEMI |
NPI Number: | 1093126708 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | A-GNP |
License Number: | RN202394 |
Business Practice Address: | 367 Athens Hwy Ste 1050 Loganville, GA - 300522204 |
Business Phone Number: | 7705542999 |
Business Fax Number: | 6783536979 |
Mailing Address: | 469 Corbin Oak Rdg, GRAYSON |
State: | GA |
Postal Code: | 300177866 |
Phone Number: | 7705570041 |
Fax Number: | 6783536979 |
NPI Enumeration Date: | 05/15/2014 |
NPI Last Update Date: | 05/15/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LG0600X |
License Number: | RN202394 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Gerontology |
Taxonomy Definition: |