Provider Demographics
NPI:1174018386
Name:OLATUNDE, ADEKUNLE (NP)
Entity Type:Individual
Prefix:
First Name:ADEKUNLE
Middle Name:
Last Name:OLATUNDE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 CLAYTON RDG
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-2608
Mailing Address - Country:US
Mailing Address - Phone:404-424-2091
Mailing Address - Fax:
Practice Address - Street 1:2219 CLAYTON RDG
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-2608
Practice Address - Country:US
Practice Address - Phone:404-424-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA211997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily