Provider Demographics
NPI:1649656083
Name:AGBEBI, OLUWAKEMI
Entity type:Individual
Prefix:
First Name:OLUWAKEMI
Middle Name:
Last Name:AGBEBI
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 1:2030 RHINEHART RD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1871
Mailing Address - Country:US
Mailing Address - Phone:678-531-1092
Mailing Address - Fax:
Practice Address - Street 1:2030 RHINEHART RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1871
Practice Address - Country:US
Practice Address - Phone:678-531-1092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN182519163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine