Provider Demographics
NPI:1023816220
Name:AKINTIMEHIN-UBEKU, OMOWUMI MARY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:OMOWUMI
Middle Name:MARY
Last Name:AKINTIMEHIN-UBEKU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:89 STALLION WAY
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2347
Mailing Address - Country:US
Mailing Address - Phone:770-256-3578
Mailing Address - Fax:855-225-5538
Practice Address - Street 1:4284 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-3534
Practice Address - Country:US
Practice Address - Phone:855-633-2949
Practice Address - Fax:855-225-5538
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN249678363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner