Provider Demographics
NPI:1407606460
Name:ADENOMO, OSARIETINME A (LMT)
Entity Type:Individual
Prefix:
First Name:OSARIETINME
Middle Name:A
Last Name:ADENOMO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4134 ELIZA DR
Mailing Address - Street 2:
Mailing Address - City:STONECREST
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6525
Mailing Address - Country:US
Mailing Address - Phone:262-353-1259
Mailing Address - Fax:
Practice Address - Street 1:483 MORELAND AVE NE STE 1
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1530
Practice Address - Country:US
Practice Address - Phone:262-353-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT013247225700000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist