Provider Demographics
NPI:1780076182
Name:ABIODUN, DOLAPO O (NP)
Entity type:Individual
Prefix:
First Name:DOLAPO
Middle Name:O
Last Name:ABIODUN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DOLAPO
Other - Middle Name:
Other - Last Name:ABIODUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1661 TABOR DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2824
Mailing Address - Country:US
Mailing Address - Phone:678-231-9721
Mailing Address - Fax:
Practice Address - Street 1:1661 TABOR DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2824
Practice Address - Country:US
Practice Address - Phone:678-231-9721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP221403363LP0808X
GARN186519363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN186519OtherLICENSE