Individual provider Active NPI

Kolawole J Adeyeye

  • Nursing Care Agency
  • Snellville, GA
National Provider Identifier
1780174953
Registry record updated May 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Care AgencyTaxonomy code 251J00000X
License
067-R-1574 Issued in GA
Practice address
4729 Polly PL
Snellville, GA 30039
Phone
(404) 944-1060
NPI assigned
May 14, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X 067-R-1574 GA Primary

Addresses

Primary practice location

4729 Polly PL
Snellville, GA 30039

Mailing address

4729 Polly PL
Snellville, GA 30039-7120
Phone (404) 944-1060

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
067-R-1574GAMDNursing Care Agency

NPI Registry JSON

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

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526342400000",
    "number": "1780174953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4729 POLLY PL",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300397120",
            "telephone_number": "404-944-1060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4729 POLLY PL",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "30039",
            "telephone_number": "404-944-1060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEYEYE",
        "first_name": "KOLAWOLE",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-14",
        "last_updated": "2018-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "GA",
            "license": "067-R-1574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Snellville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2018; 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.