Provider Demographics
NPI:1861271975
Name:ADIGUN, AISHA
Entity type:Individual
Prefix:
First Name:AISHA
Middle Name:
Last Name:ADIGUN
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 1:5385 FIVE FORKS TRICKUM RD STE F
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3018
Mailing Address - Country:US
Mailing Address - Phone:770-766-3003
Mailing Address - Fax:770-599-5966
Practice Address - Street 1:5385 FIVE FORKS TRICKUM RD STE F
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3018
Practice Address - Country:US
Practice Address - Phone:770-766-3003
Practice Address - Fax:770-599-5966
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN286228363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health