Provider Demographics
NPI:1033580568
Name:AJAYI, ABISOLA A (NP)
Entity Type:Individual
Prefix:MS
First Name:ABISOLA
Middle Name:A
Last Name:AJAYI
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-981-5431
Mailing Address - Fax:770-981-5515
Practice Address - Street 1:5700 HILLANDALE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4103
Practice Address - Country:US
Practice Address - Phone:770-981-5431
Practice Address - Fax:770-981-5515
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2023-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN210095363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003173644JMedicaid
GA202I508927OtherMEDICARE PTAN