Provider Demographics
NPI:1659926996
Name:AGBOOLA, JOY
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:AGBOOLA
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 1:2341 CHEROKEE VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5383
Mailing Address - Country:US
Mailing Address - Phone:347-654-7922
Mailing Address - Fax:
Practice Address - Street 1:2341 CHEROKEE VALLEY CIR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-5383
Practice Address - Country:US
Practice Address - Phone:347-654-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide