Provider Demographics
NPI:1700515608
Name:OMOLE, FOLASADE (PMHNP)
Entity Type:Individual
Prefix:
First Name:FOLASADE
Middle Name:
Last Name:OMOLE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 ADAMS LANDING WAY
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-5069
Mailing Address - Country:US
Mailing Address - Phone:678-677-2508
Mailing Address - Fax:
Practice Address - Street 1:2750 ADAMS LANDING WAY
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-5069
Practice Address - Country:US
Practice Address - Phone:678-677-2508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2021230505363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health