Provider Demographics
NPI:1477252047
Name:GBADEHAN, DOLAPO JUSTINAH (NP)
Entity Type:Individual
Prefix:
First Name:DOLAPO
Middle Name:JUSTINAH
Last Name:GBADEHAN
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 1:3890 REDWINE RD SW STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5583
Mailing Address - Country:US
Mailing Address - Phone:404-344-0059
Mailing Address - Fax:404-344-9195
Practice Address - Street 1:3890 REDWINE RD SW STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5583
Practice Address - Country:US
Practice Address - Phone:404-344-0059
Practice Address - Fax:404-344-9195
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily