Provider Demographics
NPI:1871193037
Name:ADENUGA, OLAKEMI L (RN)
Entity Type:Individual
Prefix:MS
First Name:OLAKEMI
Middle Name:L
Last Name:ADENUGA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:OLAKEMI
Other - Middle Name:LILIAN
Other - Last Name:ADENUGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1105 GRACE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2273
Mailing Address - Country:US
Mailing Address - Phone:770-904-0354
Mailing Address - Fax:
Practice Address - Street 1:1700 MEDICAL WAY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2195
Practice Address - Country:US
Practice Address - Phone:770-736-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA170886163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse