Provider Demographics
NPI:1891280764
Name:GUARDIAN PHYSICIAN SERVICES LLC
Entity Type:Organization
Organization Name:GUARDIAN PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-947-4842
Mailing Address - Street 1:4651 ROSWELL RD STE D308
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3055
Mailing Address - Country:US
Mailing Address - Phone:404-947-4842
Mailing Address - Fax:
Practice Address - Street 1:4651 ROSWELL RD STE D308
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3055
Practice Address - Country:US
Practice Address - Phone:404-947-4842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-24
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty