Provider Demographics
NPI:1407549793
Name:AJALA, TOLUWANIMI FAVOUR
Entity Type:Individual
Prefix:MISS
First Name:TOLUWANIMI
Middle Name:FAVOUR
Last Name:AJALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 WRENHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6232
Mailing Address - Country:US
Mailing Address - Phone:470-967-5654
Mailing Address - Fax:
Practice Address - Street 1:550 WRENHAVEN CT
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6232
Practice Address - Country:US
Practice Address - Phone:470-967-5654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030081380376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide