MEDICARE: DR. PATRICIA AYOOLA OYETAKIN M.D.

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	207N00000X	Dermatology Physician	96680	GA

General Provider Information

NPI Number	:	1740592575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA AYOOLA OYETAKIN M.D.

Provider Business Mailing Address
First Line	:	5730 GLENRIDGE DR STE T100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5747
Country	:	US
Telephone Number	:	404-939-9220
Fax Number	:

Provider Business Practice Location Address
First Line	:	5730 GLENRIDGE DR STE T100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5747
Country	:	US
Telephone Number	:	404-939-9220
Fax Number	:	470-312-2157

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

Provider Enumeration Date	:	07/09/2010
Last Update Date	:	03/05/2025

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