Provider Demographics
NPI:1093126708
Name:ADEYEMI, AFUSAT OMOLARA (A-GNP)
Entity Type:Individual
Prefix:
First Name:AFUSAT
Middle Name:OMOLARA
Last Name:ADEYEMI
Suffix:
Gender:F
Credentials:A-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 CORBIN OAK RDG
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-7866
Mailing Address - Country:US
Mailing Address - Phone:770-557-0041
Mailing Address - Fax:678-353-6979
Practice Address - Street 1:50 GLENLAKE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-3488
Practice Address - Country:US
Practice Address - Phone:833-917-2106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN202394363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology