Olusola Adeyemi
Individual provider Active NPI Registered Nurse · Decatur, GA
NPI 1104270503 · NPPES record last updated Apr 21, 2016
Key facts
- NPI
- 1104270503
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- RN104191 (GA)
- Practice address
- 455 Winn Way
Decatur, GA 30030-1707 - Phone
- (404) 294-3745
- NPI assigned
- Apr 21, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN104191 | GA | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dekalb Community Service Board | Past | Accepting new patients | |
| Dekalb Community Service Board | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN104191 | GA | Yes |
Addresses
Primary practice location
455 Winn Way
Decatur, GA 30030-1707
Mailing address
455 Winn Way
Decatur, GA 30030-1707
Phone (404) 294-3745
Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.