Omotola Omolayo, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10744 Issued in GA

Practice address

652 Bellemeade Ave NW
Atlanta, GA 30318-3102

Phone

(678) 705-8166

NPI assigned

Mar 7, 2022

Last updated

Apr 11, 2024By 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

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

Medicare enrollment (NPD)

Enrolled

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.

• Southside Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Atlanta, GA
  • NPI 1235123993
  Medicare reassignment NPD
• Southside Medical Center, Inc

  dba Southside Medical Center School Based Health Center at Lee Elementary School

  • Federally Qualified Health Center (FQHC)
  • Jonesboro, GA
  • NPI 1821981234
  NPD
• GPC Psychiatry

  • Psychiatry Physician
  • Atlanta, GA
  • NPI 1104539469
  NPD (past)

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

{
    "created_epoch": "1646611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1669129862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "652 BELLEMEADE AVE NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303183102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "652 BELLEMEADE AVE NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303183102",
            "telephone_number": "678-705-8166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMOLAYO",
        "first_name": "OMOTOLA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-07",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "10744",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Omni Primary Care, PC
• Omni Surgical, Inc
• Omni Surgical, Inc
• Omni Tech LLC
• Olumuyiwa O. Omolayo, MD
• Folashade Omole, MD
• Oluwakorede Oswald Omole
• Idanesi Nacole Omonua
• Amanda Omorogbe, NP
• Amenze Omoruyi

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.