Olivia T Agboola
Individual provider Active NPI Family Nurse Practitioner · McDonough, GA
NPI 1568022671 · NPPES record last updated Jun 20, 2019
Key facts
- NPI
- 1568022671
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- RN209875 (GA)
- Practice address
- 135 Henry Pkwy
McDonough, GA 30253-6636 - Phone
- (770) 288-6155
- Fax
- (770) 954-2269
- NPI assigned
- Jun 20, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry County Board of Health | Past |
Accepting new patients |
Interoperability endpoints
- olivia.agboola.1@18358.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN209875 | GA | Yes |
Addresses
Primary practice location
135 Henry Pkwy
McDonough, GA 30253-6636
Mailing address
4001 S River LN
Ellenwood, GA 30294-3293
Phone (678) 357-6069
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | olivia.agboola@dph.ga.gov |
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All providers in McDonough, GA · Family Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2019. 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.