Provider Demographics
NPI:1467916882
Name:KOLO, OGHALEOGHENE (NP)
Entity Type:Individual
Prefix:
First Name:OGHALEOGHENE
Middle Name:
Last Name:KOLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-3853
Mailing Address - Country:US
Mailing Address - Phone:678-520-4179
Mailing Address - Fax:
Practice Address - Street 1:3250 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-3853
Practice Address - Country:US
Practice Address - Phone:678-520-4179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230117363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily