Provider Demographics
NPI:1669645982
Name:AKOMOLAFE, 'TOLA O CHARLES (DPT)
Entity Type:Individual
Prefix:DR
First Name:'TOLA
Middle Name:O CHARLES
Last Name:AKOMOLAFE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 EAGLES LANDING WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8802
Mailing Address - Country:US
Mailing Address - Phone:770-507-2380
Mailing Address - Fax:
Practice Address - Street 1:101 BECKETT LN
Practice Address - Street 2:SUITE 402
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7155
Practice Address - Country:US
Practice Address - Phone:770-507-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT4336225100000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist