Provider Demographics
NPI:1487038931
Name:WORKMAN, OLUYEMI
Entity Type:Individual
Prefix:
First Name:OLUYEMI
Middle Name:
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 HIGHWAY 211 NW STE 6A
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-3403
Mailing Address - Country:US
Mailing Address - Phone:770-800-1044
Mailing Address - Fax:
Practice Address - Street 1:2095 HIGHWAY 211 NW STE 6A
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-3403
Practice Address - Country:US
Practice Address - Phone:770-800-1044
Practice Address - Fax:770-800-7659
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015191223X0400X
GADN015019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics