Provider Demographics
NPI:1013614668
Name:KILANI, OYEBISI MORILIAT
Entity Type:Individual
Prefix:
First Name:OYEBISI
Middle Name:MORILIAT
Last Name:KILANI
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 1:2857 TREESIDE TER
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-1115
Mailing Address - Country:US
Mailing Address - Phone:470-272-5945
Mailing Address - Fax:
Practice Address - Street 1:240 MITCHELL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2043
Practice Address - Country:US
Practice Address - Phone:770-910-9196
Practice Address - Fax:770-910-9196
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN296953363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health