Provider Demographics
NPI:1255045878
Name:UMOREN, FOLASHADE TAIWO
Entity type:Individual
Prefix:
First Name:FOLASHADE
Middle Name:TAIWO
Last Name:UMOREN
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 1:330 MICHIGAN CIR
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-5548
Mailing Address - Country:US
Mailing Address - Phone:770-309-4140
Mailing Address - Fax:
Practice Address - Street 1:330 MICHIGAN CIR
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-5548
Practice Address - Country:US
Practice Address - Phone:770-309-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN172088363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health