Provider Demographics
NPI:1255623831
Name:TIAMIYU, TITILAYO (RN)
Entity type:Individual
Prefix:MRS
First Name:TITILAYO
Middle Name:
Last Name:TIAMIYU
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 RIDGE AVE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-1640
Mailing Address - Country:US
Mailing Address - Phone:404-688-1350
Mailing Address - Fax:
Practice Address - Street 1:6500 WHITTLESEY BLVD
Practice Address - Street 2:APT 1007
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-7261
Practice Address - Country:US
Practice Address - Phone:706-221-2930
Practice Address - Fax:706-221-2930
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201670163WG0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice