Olivia T Agboola

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN209875 Issued in GA

Practice address

135 Henry Pkwy
McDonough, GA 30253-6636

Phone

(770) 288-6155

Fax

(770) 954-2269

NPI assigned

Jun 20, 2019

Last updated

Jun 20, 2019By 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 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Interoperability endpoints

• Direct secure messaging: olivia.agboola.1@18358.direct.athenahealth.com

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.

• Henry County Board of Health

  dba Henry County Health Department

  • State or Local Public Health Clinic/Center
  • McDonough, GA
  • NPI 1447325600
  NPD (past)

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

{
    "created_epoch": "1560988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560988800000",
    "number": "1568022671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 S RIVER LN",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302943293",
            "telephone_number": "678-357-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 HENRY PKWY",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302536636",
            "telephone_number": "770-288-6155",
            "fax_number": "770-954-2269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGBOOLA",
        "first_name": "OLIVIA",
        "middle_name": "T",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-20",
        "last_updated": "2019-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN209875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "olivia.agboola@dph.ga.gov",
            "affiliation": "N",
            "address_1": "135 Henry Pkwy",
            "city": "McDonough",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302536636",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Family Nurse Practitioner in McDonough, GA
• Providers in McDonough, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2019; 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.