Provider Demographics
NPI:1194984690
Name:COLLECTIVE CONSULTING ENTERPRISE
Entity type:Organization
Organization Name:COLLECTIVE CONSULTING ENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABIMBOLA
Authorized Official - Middle Name:ABOSEDE
Authorized Official - Last Name:OKUNSANYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-379-4557
Mailing Address - Street 1:6555 SUGARLOAF PKWY
Mailing Address - Street 2:SUITE 307,#231
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:678-379-4557
Mailing Address - Fax:678-475-3992
Practice Address - Street 1:6555 SUGARLOAF PKWY
Practice Address - Street 2:SUITE 307,#231
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4930
Practice Address - Country:US
Practice Address - Phone:678-379-4557
Practice Address - Fax:678-475-3992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004091363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty