Ibukunoluwa Olaoye

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12685 Issued in GA

Practice address

400 Tower Rd NE Ste 200
Marietta, GA 30060-9412

Phone

(770) 422-1372

NPI assigned

Oct 4, 2024

Last updated

Mar 28, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wellstar Medical Group, LLC

  dba WellStar Family Medicine ACW

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment Care Compare group
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD
• Wellstar Medical Group, LLC

  dba WellStar Pain Medicine

  • Pain Medicine (Anesthesiology) Physician
  • Marietta, GA
  • NPI 1972907293
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1728000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743120000000",
    "number": "1386463651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 MELROSE CREEK DR",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302812351",
            "telephone_number": "678-571-4455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 TOWER RD NE STE 200",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300609412",
            "telephone_number": "770-422-1372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLAOYE",
        "first_name": "IBUKUNOLUWA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-04",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iolaoye605420@directwellstar.org",
            "affiliation": "N",
            "address_1": "400 Tower Rd NE Ste 200",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300609412",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kate Uzoamaka Okpukpara, PHARMD
• Morgan Alexis Okundaye
• Yetunde Ronke Olagbende
• Alexi Olague
• Roy Olaitan
• Tiwalade Olawuyi, NP
• Old Piedmont Eye Group LLC (Dorfzaun Eye Group)
• Michael Ryan Oldenburg, NP
• Victoria Christa Oldham, OTR/L
• Malory Kay Olejack, MA, LPC

• Physician Assistant in Marietta, GA
• Providers in Marietta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.