Healthcare Provider Details

I. General information

NPI: 1306547799
Provider Name (Legal Business Name): ADETUNJI ATEWOLOGUN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 RHODE ISLAND AVE NW
WASHINGTON DC
20001-4153
US

IV. Provider business mailing address

915 RHODE ISLAND AVE NW
WASHINGTON DC
20001-4153
US

V. Phone/Fax

Practice location:
  • Phone: 202-232-6100
  • Fax: 202-232-0310
Mailing address:
  • Phone: 202-232-6100
  • Fax: 202-232-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: