MEDICARE: DR. MOYO SHANIECE AKINLOTAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH023273	GA

General Provider Information

NPI Number	:	1184744757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOYO SHANIECE AKINLOTAN

Provider Business Mailing Address
First Line	:	1 N ZACK HINTON PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-2316
Country	:	US
Telephone Number	:	770-914-6317
Fax Number	:

Provider Business Practice Location Address
First Line	:	1721 WATERFORD LNDG
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-7728
Country	:	US
Telephone Number	:	678-272-2740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	07/08/2007

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