Provider Demographics
NPI:1366796088
Name:AKINKUOYE, GEORGE OLUSOLA (NP)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:OLUSOLA
Last Name:AKINKUOYE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 UNION AVENUE,
Mailing Address - Street 2:APT 4
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6348
Mailing Address - Country:US
Mailing Address - Phone:508-733-5951
Mailing Address - Fax:774-244-4129
Practice Address - Street 1:264 UNION AVE
Practice Address - Street 2:APT 4
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6348
Practice Address - Country:US
Practice Address - Phone:508-733-5951
Practice Address - Fax:774-244-4129
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MANP233605101YM0800X
MA233605101YP2500X
MARN233605363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional