Individual provider Active NPI

Taiye Olubuyide, NP

  • Nurse Practitioner
  • Lawrenceville, GA
National Provider Identifier
1437217932
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN104520 Issued in GA
Practice address
2990 Five Forks Trickum Rd
Lawrenceville, GA 30044-5872
Phone
(713) 935-0333
NPI assigned
Dec 5, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN104520 GA Primary

Addresses

Primary practice location

2990 Five Forks Trickum Rd
Lawrenceville, GA 30044-5872

Mailing address

904 Masters Walk
Stone Mountain, GA 30087-6087
Phone (770) 465-2612

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)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN104520GAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Take Care Health Georgia, P.C. Past Accepting new patients
Rediclinic LLC Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437217932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 MASTERS WALK",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300876087",
            "telephone_number": "770-465-2612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 FIVE FORKS TRICKUM RD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300445872",
            "telephone_number": "713-935-0333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLUBUYIDE",
        "first_name": "TAIYE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN104520",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.