Provider Demographics
NPI:1780112789
Name:ABDUL, MARY TEMILOLA (RN-BC, MSN, FNP-BC)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:TEMILOLA
Last Name:ABDUL
Suffix:
Gender:F
Credentials:RN-BC, MSN, FNP-BC
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Mailing Address - Street 1:2258 TRIPLE CROWN LN
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-2101
Mailing Address - Country:US
Mailing Address - Phone:646-880-7317
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:939 BOB ARNOLD BLVD STE A&F
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-3258
Practice Address - Country:US
Practice Address - Phone:770-769-1724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2024-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF341113-1363LF0000X
GARN301836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily