Provider Demographics
NPI:1396294237
Name:OWOLABI, BASIRAT SAID (NP-C)
Entity type:Individual
Prefix:
First Name:BASIRAT
Middle Name:SAID
Last Name:OWOLABI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 ROSELANE ST NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6940
Mailing Address - Country:US
Mailing Address - Phone:770-792-9800
Mailing Address - Fax:770-794-7150
Practice Address - Street 1:613 ROSELANE ST NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6940
Practice Address - Country:US
Practice Address - Phone:770-792-9800
Practice Address - Fax:770-794-7150
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN193411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily