Provider Demographics
NPI:1467610139
Name:OGUNLEYE-MARTINS, ANDREW (CSA)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:OGUNLEYE-MARTINS
Suffix:
Gender:M
Credentials:CSA
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Mailing Address - Street 1:5881 GLENRDG DR NE
Mailing Address - Street 2:STE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5301
Mailing Address - Country:US
Mailing Address - Phone:404-667-0118
Mailing Address - Fax:404-303-7706
Practice Address - Street 1:5881 GLENRIDGE DR NE
Practice Address - Street 2:STE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5574
Practice Address - Country:US
Practice Address - Phone:404-303-7703
Practice Address - Fax:404-303-7706
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2017-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA97-131363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical