Provider Demographics
NPI:1093126708
Name:ADEYEMI, AFUSAT
Entity type:Individual
Prefix:
First Name:AFUSAT
Middle Name:
Last Name:ADEYEMI
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 1:469 CORBIN OAK RDG
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-7866
Mailing Address - Country:US
Mailing Address - Phone:770-557-0041
Mailing Address - Fax:678-353-6979
Practice Address - Street 1:602 GREEN ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-6054
Practice Address - Country:US
Practice Address - Phone:762-334-3392
Practice Address - Fax:762-212-4352
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN202394363LG0600X, 363LP0808X
COC-APN0102132-C-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology