Provider Demographics
NPI:1316455066
Name:OLATUNJI, OLATUNDE SYNTHIA
Entity type:Individual
Prefix:MRS
First Name:OLATUNDE
Middle Name:SYNTHIA
Last Name:OLATUNJI
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 1:6011 HENDRIX LN
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-3483
Mailing Address - Country:US
Mailing Address - Phone:404-496-4461
Mailing Address - Fax:
Practice Address - Street 1:6011 HENDRIX LN
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-3483
Practice Address - Country:US
Practice Address - Phone:404-496-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA216620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily