Provider Demographics
NPI:1457018012
Name:BADEJOH, OLUBUKOLA (FNP)
Entity Type:Individual
Prefix:DR
First Name:OLUBUKOLA
Middle Name:
Last Name:BADEJOH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 ASHWOOD GROVE PARK
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2954
Mailing Address - Country:US
Mailing Address - Phone:404-983-1665
Mailing Address - Fax:
Practice Address - Street 1:3144 ASHWOOD GROVE PARK
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2954
Practice Address - Country:US
Practice Address - Phone:404-983-1665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2020130034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily