Olasumbo Oluwakemi Dada

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

RN186907 Issued in GA

Practice address

Mach
6600 Van Aalst Blvd
Ft. Moore, GA 31905

Phone

(719) 231-9213

NPI assigned

Oct 16, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1350345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1477806461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 MEADOW VALLEY CT",
            "city": "MIDLAND",
            "state": "GA",
            "postal_code": "318204393",
            "telephone_number": "719-231-9213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MACH",
            "address_2": "6600 VAN AALST BLVD",
            "city": "FT. MOORE",
            "state": "GA",
            "postal_code": "31905",
            "telephone_number": "719-231-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DADA",
        "first_name": "OLASUMBO",
        "middle_name": "OLUWAKEMI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-16",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN186907",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN186907",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Charlton Cooper, OTR/L
• Nicole M Costell
• Jeremy Keith Crouch, CRNA
• Deana Cruz
• Cindy Rosemarie Dad, MSW, LCSW, LAC
• Jessica Laurel Dawson, LCSW
• Timothy Michael Duff, DPT
• Ronald Reid Durbin III, MD
• Ebere Emmanuel, PHARM.D.
• Eli English, PT, DPT

• Adult Health Nurse Practitioner in Fort Moore, GA
• Providers in Fort Moore, GA by specialty
• Adult Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; 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.