Provider Demographics
NPI:1972287696
Name:AYO, CAROLINE OLUFUNKE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:OLUFUNKE
Last Name:AYO
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 1:3640 DRAYTON MANOR RUN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-9425
Mailing Address - Country:US
Mailing Address - Phone:770-617-7600
Mailing Address - Fax:
Practice Address - Street 1:3640 DRAYTON MANOR RUN
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-9425
Practice Address - Country:US
Practice Address - Phone:770-617-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN269922363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health