Provider Demographics
NPI:1104287283
Name:OGUN-SEMORE, OLAWUNMI
Entity type:Individual
Prefix:
First Name:OLAWUNMI
Middle Name:
Last Name:OGUN-SEMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:OLAWUNMI
Other - Middle Name:YETUNDE
Other - Last Name:OGUN-SEMORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC, ACPCNP-C
Mailing Address - Street 1:11815 NORTHFALL LN STE 1001
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-7973
Mailing Address - Country:US
Mailing Address - Phone:425-659-5073
Mailing Address - Fax:770-502-6956
Practice Address - Street 1:11815 NORTHFALL LN STE 1001
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7973
Practice Address - Country:US
Practice Address - Phone:425-659-5073
Practice Address - Fax:770-502-6956
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA182005363LA2200X, 363LP0808X, 363LP0808X
GARN182005363LG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology