Provider Demographics
NPI:1427644970
Name:AMOSU, OLUWASEYI OLOLADE (PHD)
Entity type:Individual
Prefix:DR
First Name:OLUWASEYI
Middle Name:OLOLADE
Last Name:AMOSU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E PONCE DE LEON AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3452
Mailing Address - Country:US
Mailing Address - Phone:678-799-7576
Mailing Address - Fax:678-799-7576
Practice Address - Street 1:235 E PONCE DE LEON AVE STE 220
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3452
Practice Address - Country:US
Practice Address - Phone:678-799-7576
Practice Address - Fax:678-799-7576
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA004518103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty