Provider Demographics
NPI:1508335563
Name:ODUJEBE, OLUBUKOLA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:OLUBUKOLA
Middle Name:
Last Name:ODUJEBE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:OLUBUKUNOLA
Other - Middle Name:
Other - Last Name:ODUJEBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1400 VETERANS MEMORIAL HWY SE STE 134-400
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2945
Mailing Address - Country:US
Mailing Address - Phone:678-361-6375
Mailing Address - Fax:877-800-9890
Practice Address - Street 1:445 WINN WAY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1707
Practice Address - Country:US
Practice Address - Phone:678-361-6375
Practice Address - Fax:877-800-9890
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN206626363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily