Provider Demographics
NPI:1841761004
Name:ADEKOLA, ATINUKE
Entity Type:Individual
Prefix:
First Name:ATINUKE
Middle Name:
Last Name:ADEKOLA
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 1:798 ROCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-3674
Mailing Address - Country:US
Mailing Address - Phone:404-236-4136
Mailing Address - Fax:
Practice Address - Street 1:798 ROCKINGHAM DR
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-3674
Practice Address - Country:US
Practice Address - Phone:404-236-4136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN221678363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN221678OtherADVANCE PRACTICE REGISTERED NURSE